Coding Sinusitis – A Chronic Infectious Condition of Paranasal Sinuses

The article gives a detailed overview of Sinusitis along with its causes, types, symptoms and treatment. 

Sinusitis is a common infectious condition that causes inflammation or swelling of the paranasal sinuses, i.e. tissues lining the sinuses.  The condition generally occurs when mucus builds up, and the sinuses become irritated and inflamed. Located behind the forehead, nose, cheekbones, and in between the eyes, the sinuses are small air pockets that produce mucus (a thin and flowing liquid) that protects the body by trapping and moving germs away. According to the American College of Allergy, Asthma & Immunology, sinus infection is a common condition that affects about 31 million people in the United States (2019 statistics). The condition can affect anyone. However, it is more common among people with nasal allergies, nasal polyps, asthma and abnormal nose structures. The habit of smoking can also increase the chances of getting a sinus infection. Although painful, sinusitis often goes away without medical intervention. However, if the symptoms become severe and persistent, the patient must consult a physician. If left untreated, sinus infection can cause severe complications like - an abscess, a walled off collection of infection (with pus in the sinus cavity), meningitis, and orbital cellulitis (an infection of the tissue surrounding the eyes). Billing and coding for this infectious condition can be challenging. Physicians providing treatment for sinusitis need to be ready with the ICD-10 codes for the condition and a practical option is to partner with an experienced company outsourcing billing services. 

Causes and Types of Sinusitis

Sinusitis can occur due to various factors. It most commonly occurs when fluid gets trapped in the sinuses, allowing germs to grow. One of the common causes of this condition is a virus, but a bacterial infection can also lead to sinusitis. Common triggers include – allergies and asthma, pollutants in the air (like chemicals and other irritants), and fungal infections. There are different types of sinus infections and they can last for various lengths of time - 

• Acute Sinusitis – A common sinusitis with the shortest duration, acute sinusitis is caused by a viral infection brought on by a common cold or seasonal allergy. Symptoms go away within 7–10 days, but can last up to 4 weeks. 
• Subacute Sinusitis - It commonly results from bacterial infections or seasonal allergies. The symptoms can last for up to 3 months. 
• Chronic Sinusitis – This type of sinusitis can occur due to bacterial infections, persistent allergies, or structural problems of the nose. It is estimated that more than 50 percent of people with moderate to severe asthma also have chronic sinusitis. Symptoms may last for more than 3 months or return three times within a year.

The treatment and recovery time associated with sinusitis may depend on the type of sinusitis and the associated symptoms. 

Signs and Symptoms of Sinusitis 

Detecting the signs and symptoms of sinusitis is often difficult, especially among children. In most cases, the symptoms are similar to those of a common cold. Symptoms of acute, sub-acute, and chronic sinus infections are similar. However, the severity and length of symptoms may vary. Some of the common symptoms include – 

• Nasal discharge (which may be green or yellow)
• Toothache
• Tenderness and swelling around the eyes, nose, cheeks, and forehead
• Stuffy or runny nose
• Sore throat and cough
• Fever and headaches
• Facial pain or pressure
• Bad breath
• A reduced sense of smell and taste
• A postnasal drip (where mucus runs down the back of the throat)

Any person can develop a sinus infection. However, certain health conditions and risk factors like a deviated nasal septum, nasal bone spurs, weak immune system, history of allergies, dental infections, cystic fibrosis, and tobacco smoking can increase the chances of developing the condition. 

How to Diagnose and Treat Sinus Infections

In most cases, people can usually manage sinusitis at home. However, if certain symptoms associated with the condition last longer than 10 days (without improvement), does not improve with over-the-counter (OTC) medication, patients experience vision changes or swelling around the eyes, or have a fever that lasts longer than 3–4 days or is over 101.5°F (38.6°C) – it is important to immediately consult a physician. As part of the diagnosis, physicians will ask about the symptoms and conduct a detailed physical examination. They may check for pressure and tenderness by pressing a finger against the head and cheeks and also carry out an allergy test to identify possible triggers. Physicians may also perform an MRI or CT scan to check for structural problems. 

A fiberoptic scope (a lighted tube that passes through the nose) may be used to visualize the inside part of nasal passages, sinuses and look for signs of inflammation. These tests can reveal mucus blockages and any abnormal structures, such as polyps. A sample may be obtained during nasal endoscopy for culture testing to test for the presence of an infection. Blood tests may also be performed to check for diseases that weaken the immune system, such as HIV. 

Treatment modalities include a combination of home remedies, medications and surgical intervention (in extreme cases). In about 70% of cases, acute sinusitis resolves without prescription drugs. Various home remedies such as nasal irrigation, steam inhalation, warm compresses, decongestant tablets and sprays combined with rest can help relieve symptoms. Antibiotics (such as acetaminophen and ibuprofen), corticosteroid sprays or tablets may be prescribed to reduce the severity of symptoms that don’t improve within a couple of weeks. If chronic cases of sinusitis don’t improve with time and medication, surgery could be considered as an option. Surgery is performed to clear the sinuses, repair a deviated septum, or remove polyps. However, surgery may not resolve the problem completely. The patient may need to continue other treatments even after surgery to stop sinusitis from returning.

Billing and coding for sinusitis can be challenging. Physicians administering treatment for this condition must use the relevant ICD-10 codes to bill for the procedure. ICD-10 diagnosis codes for sinusitis include – 

Acute Sinusitis

J01 Acute sinusitis

J01.0 Acute maxillary sinusitis

J01.1 Acute frontal sinusitis

J01.2 Acute ethmoidal sinusitis

J01.3 Acute sphenoidal sinusitis

J01.4 Acute pansinusitis

J01.8 Other acute sinusitis

• J01.80 Other acute sinusitis
• J01.81 Other acute recurrent sinusitis

J01.9 Acute sinusitis, unspecified

• J01.90 Acute sinusitis, unspecified
• J01.91 Acute recurrent sinusitis, unspecified

Chronic Sinusitis

• J32 Chronic sinusitis
• J32.0 Chronic maxillary sinusitis
• J32.1 Chronic frontal sinusitis
• J32.2 Chronic ethmoidal sinusitis
• J32.3 Chronic sphenoidal sinusitis
• J32.4 Chronic pansinusitis
• J32.8 Other chronic sinusitis
• J32.9 Chronic sinusitis, unspecified

Mostly, sinus infections are treatable, and most people recover without consulting a physician, taking antibiotics or by following other home remedies. As these infections can develop after a cold, flu, or allergic reaction, incorporating a healthy lifestyle and reducing exposure to germs and allergens can help prevent an infection in the long run. Incorporating several strategies like – practicing good hand hygiene, avoiding smoking and exposure to secondhand smoke, chemicals, pollen, and other allergens or irritants, keeping vaccinations up to date and avoiding and managing allergens when possible – can help reduce the risk associated with the condition in the long run. 

Medical billing and coding for different types of sinus infections can be complex. With outsourced billing services from reputable medical billing companies, healthcare providers can ensure correct and timely medical billing and claims submission.