Anesthesia Coding Alert

You’ll still have 7 choices to consider.

Chronic obstructive pulmonary disease (COPD) is one condition that can complicate surgeries and lead to more intensive work for the anesthesiologist. The good news from a coding perspective is that ICD-10’s options for the condition are very similar to the codes you used under ICD-9.

The seven base COPD codes in ICD-9 were:

• 490 — Bronchitis, not specified as acute or chronic
• 491 — Chronic bronchitis
• 492 — Emphysema
• 493 — Asthma
• 494 — Bronshiectasis
• 495 — Extrinsic allergic alveolitis
• 496 — Chronic airway obstruction, not elsewhere classified.

ICD-10 versions: Now you’ll turn to the following base codes:

• J40 — Bronchitis, not specified as acute or chronic
• J41 — Simple and mucopurulent chronic bronchitis
• J42 — Unspecified chronic bronchitis
• J43 — Emphysema
• J44 — Other chronic obstructive pulmonary disease
• J45 — Asthma
• J47 — Bronchiectasis.

Note that while the ICD-9 codes expanded up to five digits, you’ll need to go out to a fifth or even a sixth character for more specificity in ICD-10.

Heads up: Some coding confusion may ensue when a code excludes a complication. If you have a patient that has COPD with a complication of acute bronchitis, you will use J44.0 (Chronic obstructive pulmonary disease with acute lower respiratory infection), but you will also need J20.- (Acute bronchitis, …).

“With all the specificity needed for ICD-10, looking at these respiratory issues shows that we had the specificity needed for ICD-10 in ICD-9,” says Suzan Hauptman, MPM, CPC, CEMC, CEDC, director of coding operations at Allegheny Health Network in Pittsburgh, Pa. “For a many physicians, the transition from one set to the other will be a smooth transition.”

---