What Does ICD-10 Code D86.0 Mean?
ICD-10 code D86.0 designates a diagnosis of pulmonary sarcoidosis — a systemic granulomatous disease in which non-caseating granulomas form specifically within the lung tissue. D86.0 is a valid, billable diagnosis code applicable in both inpatient and outpatient settings for fiscal year 2025. It falls under the broader sarcoidosis category (D86), which spans multiple organ systems, but D86.0 is reserved exclusively for pulmonary involvement.
Key attributes of this code:
- Valid and billable for FY2025 with no change to its description
- Assigned to ICD-10-CM category D86: Sarcoidosis
- Applicable to any care setting where a confirmed pulmonary sarcoidosis diagnosis is the documented reason for the encounter
- Does not require a specific disease stage to be assigned
What Conditions and Diagnoses Does D86.0 Cover?
D86.0 captures pulmonary presentations of sarcoidosis where the granulomatous infiltration is confined to or primarily involves the lungs. Clinical presentations that map to this code include:
- Bilateral hilar lymphadenopathy with confirmed pulmonary parenchymal involvement
- Sarcoid granulomas identified on transbronchial lung biopsy
- Pulmonary infiltrates consistent with sarcoidosis on imaging, supported by tissue diagnosis
- Stage II, III, or IV sarcoidosis with active pulmonary infiltrates (per Scadding classification)
- Sarcoid-related restrictive lung disease where the lung is the primary affected organ
What Does D86.0 Specifically Exclude?
D86.0 should not be assigned for the following:
- D86.1 — Sarcoidosis of the lymph nodes (pulmonary hilar nodes without lung parenchymal involvement)
- D86.2 — Sarcoidosis of both lung and lymph nodes (use when both are documented)
- D86.3 through D86.9 — Organ-specific or multisystem sarcoidosis affecting the skin, eye, liver, heart, or unspecified sites
- Any interstitial lung disease where sarcoidosis has not been confirmed by pathology or clinical diagnosis
When Is D86.0 the Right Code to Use?
Selecting D86.0 correctly depends on the precision of the provider’s documentation. Follow this decision sequence:
- Confirm the provider has documented a diagnosis of sarcoidosis — not just “suspected” or “possible” sarcoidosis (outpatient coding rules prohibit unconfirmed diagnoses)
- Verify that the documentation specifies pulmonary involvement as the primary or sole organ system affected
- Determine whether lymph node involvement is also documented — if it is, D86.2 may be more appropriate
- Rule out that the encounter is being driven by a sarcoidosis manifestation in another organ (eye, heart, skin), which would warrant a different D86.x subcategory
- Assign D86.0 only when the lung is the documented site and no more specific code captures the clinical picture
How Does D86.0 Differ From D86.2?
| Feature | D86.0 | D86.2 |
|---|---|---|
| Primary site | Lung parenchyma only | Lung and lymph nodes both documented |
| Hilar adenopathy present? | Not the primary finding | Yes, co-documented with pulmonary disease |
| When to use | Pulmonary infiltrates confirmed, no lymph node documentation | Provider explicitly documents both sites |
| Audit risk | Undercoding if lymph nodes present but ignored | Overcoding if lymph node involvement not documented |
In practice, coders frequently encounter cases where the radiologist mentions bilateral hilar adenopathy but the treating physician’s note focuses solely on parenchymal disease. In these situations, query the provider before defaulting to D86.2.
What Documentation Is Required to Support D86.0?
Accurate assignment of D86.0 rests entirely on the strength of the provider’s clinical documentation. Payers and auditors scrutinize sarcoidosis claims closely given the diagnostic complexity of the condition.
What Must the Provider Document in the Clinical Notes?
- An explicit diagnosis of pulmonary sarcoidosis — the word “sarcoidosis” with pulmonary or lung site specified
- Clinical findings consistent with the diagnosis (e.g., dyspnea, cough, reduced DLCO, restrictive pattern on PFTs)
- The basis for diagnosis — biopsy findings, radiologic findings, or clinical diagnosis when biopsy is not feasible
- Whether the condition is active, in remission, or recurrent (impacts medical necessity for ongoing management)
- Any associated manifestations being managed concurrently (e.g., hypercalcemia, fatigue)
Which Diagnostic or Lab Results Support This Code?
- Transbronchial or endobronchial biopsy showing non-caseating granulomas
- CT chest or high-resolution CT (HRCT) demonstrating perilymphatic nodules, ground-glass opacities, or fibrotic changes
- Pulmonary function test (PFT) results showing restrictive pattern with reduced DLCO
- Elevated serum ACE (angiotensin-converting enzyme) levels — supportive but not diagnostic alone
- Bronchoalveolar lavage (BAL) showing CD4:CD8 ratio greater than 3.5 (supportive finding)
- Negative AFB cultures ruling out tuberculosis (important for differential documentation)
What Is the Documentation Standard for Inpatient vs. Outpatient Settings?
| Setting | Documentation Rule |
|---|---|
| Outpatient | Only confirmed diagnoses may be coded; “possible” or “probable” sarcoidosis must not be coded — code the signs/symptoms instead |
| Inpatient | Confirmed, probable, and suspected diagnoses documented at discharge may all be coded per ICD-10-CM Official Coding Guidelines Section II |
| Both settings | Provider must explicitly link the pulmonary findings to the sarcoidosis diagnosis — incidental radiology findings alone are insufficient |
How Does D86.0 Affect Medical Billing and Claims?
Pulmonary sarcoidosis claims carry meaningful medical necessity review risk because symptoms overlap with other interstitial lung diseases and the diagnostic workup is often extensive and high-cost.
- Medicare and most commercial payers require documentation linking the specific services billed to the D86.0 diagnosis
- Prior authorization may be required for high-cost procedures like bronchoscopy with BAL, HRCT, or repeat PFTs
- Systemic corticosteroid therapy billed alongside D86.0 is generally covered when documentation supports active, progressive disease
- Immunosuppressant therapy (e.g., methotrexate, azathioprine) may trigger payer review for LCD coverage criteria
- Claims with D86.0 as a secondary code should reflect the primary reason for the encounter in position one
What CPT or Procedure Codes Are Commonly Billed With D86.0?
| CPT Code | Description | Typical Pairing Context |
|---|---|---|
| 94010 | Spirometry | PFT monitoring of disease progression |
| 94070 | Multiple spirometry with bronchodilators | Evaluating reversibility in sarcoid-related obstruction |
| 31625 | Bronchoscopy with bronchial/endobronchial biopsy | Histologic confirmation of granulomas |
| 71250 | CT thorax without contrast | Initial staging and monitoring |
| 93000 | Routine ECG | Cardiac screening in sarcoidosis patients |
| 99213–99215 | Office/outpatient E/M visits | Ongoing pulmonary management |
Are There Any Prior Authorization or Coverage Restrictions?
- Biologic agents (off-label use for refractory pulmonary sarcoidosis) almost universally require prior authorization
- Repeat HRCT imaging may face frequency restrictions under payer LCD policies
- Pulmonary rehabilitation services (CPT 94625, 94626) require documentation of functional impairment tied to the diagnosis
What Coding Errors Should You Avoid With D86.0?
Auditors commonly flag D86.0 claims for avoidable errors that stem from incomplete documentation review or failure to check the full code set before assignment.
- Assigning D86.0 when D86.2 is correct — failing to account for documented lymph node involvement
- Coding D86.0 for a suspected diagnosis in an outpatient setting — violates outpatient coding guidelines
- Omitting additional codes for manifestations — sarcoidosis-related hypercalcemia (E83.52), uveitis (H22), or cardiac arrhythmia must be coded separately when documented and managed
- Using D86.0 as a primary code when another condition drove the encounter — if the patient presents for pneumonia management and sarcoidosis is incidental, sequence accordingly
- Failing to update the code when the condition progresses — a patient initially coded with D86.0 who develops multisystem involvement may require additional D86.x codes at subsequent encounters
What Do Auditors Look for When Reviewing Claims With D86.0?
- Absence of biopsy or imaging documentation to support the diagnosis
- Mismatch between the organ site coded (lung) and the clinical notes (which may reference liver or skin involvement)
- Corticosteroid prescriptions without a documented active disease state
- Claims where D86.0 appears as the only code despite documented comorbid manifestations
How Does D86.0 Relate to Other ICD-10 Codes?
| Related Code | Relationship | Key Distinction |
|---|---|---|
| D86.1 | Sarcoidosis of lymph nodes | No pulmonary parenchymal involvement documented |
| D86.2 | Sarcoidosis of lung and lymph nodes | Both sites explicitly documented |
| D86.3 | Sarcoidosis of skin | Cutaneous granulomas; no lung involvement coded here |
| D86.81 | Sarcoid meningitis | CNS manifestation; code alongside D86.0 if both present |
| D86.89 | Sarcoidosis of other sites | Cardiac, hepatic, or bone marrow involvement |
| D86.9 | Sarcoidosis, unspecified | Use only when no organ site is documented — avoid if any specificity is available |
| J84.10 | Pulmonary fibrosis, unspecified | Distinct condition; sarcoid-related fibrosis should still be coded as D86.0 |
What Is the Correct Code Sequencing When D86.0 Appears With Other Diagnoses?
- If the patient is admitted or seen primarily for pulmonary sarcoidosis management, sequence D86.0 first
- If an acute manifestation (e.g., respiratory failure J96.xx) is the reason for admission and sarcoidosis is the underlying cause, code the manifestation first per the “code first” instructional note
- Assign additional codes for all documented and managed manifestations in the same encounter
- When sarcoidosis-related hypercalcemia is documented, add E83.52 after D86.0
- Do not code signs and symptoms (dyspnea, cough) that are integral to the sarcoidosis diagnosis — they are already captured
Real-World Coding Scenario — How D86.0 Is Applied in Practice
Encounter: A 42-year-old woman presents to a pulmonology clinic for a follow-up visit. She was diagnosed with sarcoidosis six months ago after a transbronchial biopsy confirmed non-caseating granulomas in the right lower lobe. Today’s visit addresses worsening dyspnea and a new CT showing bilateral pulmonary infiltrates. Serum calcium is elevated at 11.4 mg/dL. The pulmonologist documents “active pulmonary sarcoidosis with sarcoid-related hypercalcemia” and adjusts corticosteroid dosing. No lymph node involvement is documented.
Correct Code Application
- D86.0 — Pulmonary sarcoidosis (primary, documented reason for the encounter)
- E83.52 — Hypercalcemia (sarcoid-related, documented and managed)
- 99214 — Office visit, moderate complexity (E/M level supported by MDM)
Common Mistake in This Scenario
- Assigning D86.9 (unspecified sarcoidosis) — incorrect because the provider explicitly documented pulmonary involvement
- Omitting E83.52 — the hypercalcemia is documented and actively managed, making it a reportable secondary diagnosis
- Coding dyspnea separately — dyspnea is a symptom integral to pulmonary sarcoidosis and should not be coded in addition to D86.0
Frequently Asked Questions About ICD-10 Code D86.0
Is ICD-10 Code D86.0 Valid for Use in FY2025?
D86.0 is a valid, billable ICD-10-CM diagnosis code for fiscal year 2025 with no changes to its description or validity status. Coders should verify annually against the official ICD-10-CM tabular release published by CMS to confirm no revisions have been applied for the upcoming fiscal year.
What Is the Difference Between D86.0 and D86.9?
D86.0 is assigned when the provider has specifically documented pulmonary or lung involvement in the sarcoidosis diagnosis. D86.9 represents unspecified sarcoidosis and should only be used when the provider’s documentation contains no organ-site specificity — it carries higher audit risk and should never be used when any site information is available.
Can D86.0 Be Coded Based on Radiology Findings Alone?
D86.0 should not be assigned solely on the basis of imaging findings without a clinical diagnosis from the treating provider. A radiologist’s impression of “findings consistent with sarcoidosis” does not constitute a confirmed diagnosis under ICD-10-CM outpatient coding rules — the treating provider must independently confirm and document the diagnosis.
Does D86.0 Require a Biopsy to Be Coded?
A biopsy is not a required prerequisite for assigning D86.0. When a treating provider documents a confirmed clinical diagnosis of pulmonary sarcoidosis based on the totality of clinical evidence — including imaging, PFTs, laboratory findings, and symptom pattern — the code may be assigned. Documentation of the diagnostic reasoning strengthens the record in the event of a payer audit.
Should D86.0 or J84.10 Be Used for Sarcoid-Related Pulmonary Fibrosis?
When pulmonary fibrosis develops as a consequence of long-standing sarcoidosis, D86.0 remains the appropriate code — it captures the underlying granulomatous disease. J84.10 (pulmonary fibrosis, unspecified) is a distinct condition code for fibrosis not attributable to sarcoidosis. Assigning J84.10 in place of D86.0 constitutes a misrepresentation of the etiology.
What Happens If a Patient Has Both Pulmonary and Lymph Node Sarcoidosis?
When the provider documents involvement of both the lungs and lymph nodes, D86.2 (sarcoidosis of lung and lymph nodes) should be assigned rather than D86.0. Using D86.0 when bilateral hilar lymphadenopathy with pulmonary infiltrates is explicitly documented in the same record is a form of undercoding that may be flagged on audit.
Is D86.0 Covered by Medicare?
Medicare does cover medically necessary evaluation and management, diagnostic testing, and treatment related to a confirmed D86.0 diagnosis, provided documentation supports the medical necessity of each service billed. Coverage for specific procedures depends on applicable Local Coverage Determinations and the clinical context documented in the record.
Key Takeaways
- D86.0 is billable only when pulmonary sarcoidosis is explicitly confirmed by the treating provider — not merely suspected
- Use D86.2 when both lung parenchyma and lymph nodes are documented as involved in the same encounter
- Always code documented and managed manifestations (hypercalcemia, uveitis, arrhythmia) as additional diagnoses
- Outpatient coding prohibits assigning D86.0 for “possible” or “probable” pulmonary sarcoidosis — code signs and symptoms instead
- Biopsy is not required for code assignment but is the strongest documentation support for audit defense
- Sequencing matters: when respiratory failure complicates sarcoidosis, the manifestation typically sequences first
- Review ICD-10-CM Official Coding Guidelines annually to confirm D86.0 remains unchanged for the current fiscal year