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Bronchiolitis Obliterans Organising Pneumonia H014

Document
Last amended 
29 June 2015
Current RMA Instruments:
Reasonable Hypothesis SOP
62 of 2009
Balance of Probabilities SOP
63 of 2009
Changes from Previous Instruments:

SOP Bulletin 136

ICD Coding:
  • ICD-9-CM Codes: 516.8
  • ICD-10-AM Codes: J84.0

This SOP covers some forms of organising pneumonia, including idiopathic BOOP and some secondary (known cause) forms of organising pneumonia.  The condition may be a temporary phase which may resolve or change into another respiratory pathology.  This is a complex area.  Specialist opinion and histology will be required for diagnosis and medical adviser input should be obtained before confirming the diagnosis and applying the SOP.  See further comments, below.

Is specific diagnostic evidence required to apply the SOP? – Yes.

This diagnosis requires a specialist report on histological finding of respiratory tissue biopsy.  Imaging is non-specific and insufficient for diagnosis. It would also be useful to obtain a statement regarding the permanence of this condition.

Are there sub-factors that require specific information? – No.
Additional diagnoses covered by SOP
  • Cryptogenic organising pneumonia (COP)
  • Idiopathic bronchiolitis obliterans organising pneumonia
  • Organising pneumonia secondary to drugs
  • Organising pneumonia secondary to ionising radiation
  • Organising pneumonia secondary to local bronchial obstruction
  • Organising pneumonia secondary to toxic fumes
Conditions excluded from SOP
  • Acute Respiratory Distress Syndrome, ICD 9 code 518.5
  • Asbestosis, ICD 9 code 501
  • Bronchiectasis, ICD 9 code 494
  • Bronchiolitis obliterans (i.e. without organising pneumonia), use ICD 9 code 519.8
  • Chronic bronchitis and emphysema, ICD 9 codes 491, 492.0-8
  • Chronic Obstructive Airways Disease; Chronic Obstructive Pulmonary Disease;
  • Fibrosing interstitial lung disease, ICD 9 code 516.3
  • Histological finding with no associated clinical signs, symptoms or impairment
  • Obliterative bronchiolitis, use ICD 9 code 519.8
  • Organising pneumonia as a manifestation of systemic disease such as malignant neoplasia; systemic inflammatory condition; or autoimmune connective tissue diseases. Examples are Sarcoidosis (SOP); Systemic Lupus Erythematosus (SOP); Rheumatoid arthritis (SOP); Inflammatory bowel disease
  • Organising pneumonia due to infection. That is viral pneumonia, bacterial pneumonia, fungal pneumonia, or parasitic pneumonia
Unconfirmed diagnosis

If, after applying the above information, you are unable to confirm the diagnosis, you should then:

  1. seek medical officer advice about further investigation, or;
  2. generate a diagnostic report, or;
  3. re-encode the condition, if appropriate.
Comments

Use of the term ‘bronchiolitis obliterans organising pneumonia’, in clinical practice, may be restricted to the idiopathic form.  The term cryptogenic organising pneumonia may be used in preference, (i) because the organising pneumonia involves the alveolar ducts and alveolar spaces rather than the bronchioles, and (ii) to avoid confusion with ‘bronchiolitis obliterans’, which is a separate disease process.

The RMA has used to term ‘bronchiolitis obliterans organising pneumonia’ to also cover some but not all forms of secondary organising pneumonia.  This use may not correspond with the terminology used by clinicians or pathologists.

‘Organising’ pneumonia means pneumonia that has not yet resolved.  It may clear up, or it may go on to fibrosis or some other lung pathology.  So the condition may be temporary.

The condition may also be sub-clinical, without symptoms or other clinical evidence.  The SOP definition requires both the histological pattern and the presence of clinical disease.

Hence, there is a need to check carefully whether the claimed condition is still present and is covered by the SOP definition, before applying the SOP.  Seek medical advice if in doubt.