What is the ICD10 (International Classification of Diseases, 10th Revision) code for a paralyzed left diaphragm?

ICD-10 Code for Paralyzed Left Diaphragm

The appropriate ICD-10 code for a paralyzed left diaphragm is J98.6 (Disorders of diaphragm) with the additional specification of laterality as left (J98.6 with modifier for left side).

Coding Rationale

When coding for diaphragmatic paralysis, the following considerations are important:

1. Anatomical Specificity: The code must identify:

   • The diaphragm as the affected structure
   • Left-sided involvement (laterality)

2. Evidence-Based Classification:

   • According to the evidence, phrenic nerve injury is the most common cause of diaphragmatic paralysis 1
   • Diaphragmatic paralysis represents an extreme form of diaphragmatic weakness 2

Clinical Manifestations to Document

For proper coding, document the following clinical findings that support the diagnosis:

• Physical Examination Findings:

  • Paradoxical inward motion of the abdomen during inspiration
  • Thoracic breathing pattern
  • Absence of Litten's sign (diminished movement of the lateral chest wall during respiration)
  • Less resistance to abdominal palpation on the affected side 3

• Diagnostic Findings:

  • Elevated left hemidiaphragm on chest radiograph
  • Paradoxical upward movement of the left hemidiaphragm during fluoroscopic imaging (Kienböch's phenomenon)
  • Diminished resonance at the base of the lung 3, 2

Diagnostic Confirmation

To ensure accurate coding, the diagnosis should be confirmed by:

1. Imaging:

   • Chest radiography showing elevated left hemidiaphragm
   • Fluoroscopy demonstrating paradoxical movement (Bittorf's test) 3
   • Ultrasound assessment showing decreased or absent diaphragmatic excursion 4

2. Specialized Testing (if available):

   • Reduction in maximal static transdiaphragmatic pressure (Pdimax)
   • Absence of compound diaphragm action potential on phrenic nerve stimulation 2

Coding Pitfalls to Avoid

1. Don't confuse with other respiratory conditions that may present with similar symptoms
2. Don't use general respiratory failure codes when the specific diaphragmatic condition can be coded
3. Don't omit laterality when it is clearly documented as left-sided
4. Don't code as bilateral when only the left diaphragm is affected

Additional Coding Considerations

• If the paralyzed diaphragm is secondary to another condition (e.g., phrenic nerve injury during cardiac surgery), both conditions should be coded appropriately 1
• If respiratory failure is present as a consequence, this should be coded as an additional diagnosis

Remember that proper documentation of clinical findings, diagnostic test results, and the specific side affected (left) is essential for accurate coding of diaphragmatic paralysis.