ED Coding and Reimbursement Alert

Here's how to educate your doctors for better ICD-9 coding

Physicians base an initial diagnosis for chronic obstructive pulmonary disease (COPD) on several factors, and the best documentation will include extensive information about each factor.

Pierre Edde, MD, founder of PCS Billing in Uniontown, Pa., offers the following items that most COPD documentation should include:

- In the HISTORY: Should include whether or not the patient had a history of cigarette smoking. The vast majority of COPD patients have a history of smoking cigarettes. The remaining patients have a history of exposure to pollutants, dusts and chemicals, evidence of genetic tendency (such as alpha-1 antitrypsin) or history of chronically and poorly controlled asthma.

- In the SYMPTOMS: Shortness of breath (also known as dyspnea) and cough are the cardinal symptoms. Excessive sputum production, wheezing, and recurrent upper respiratory tract infections (URI) are commonly present in these patients.

- In the RADIOGRAPHICAL workup: The chest x-ray shows hyperinflation with flattening of the diaphragms. The CT of the chest is more sensitive and can correlate more accurately with the severity of COPD, so include details about these test results.

- In the BLOOD WORK, there are no specific findings until the advanced stage of the disease. Arterial blood gases (ABG) will show evidence of respiratory failure: In emphysema, hypoxemia tends to be more pronounced, while in chronic bronchitis, hypercapnea (CO2 retention) is more evident. Chronic hypoxemia can result in erythrocytosis (elevated hemoglobin and hematocrit) on the complete blood count (CBC), while CO2 retention will elevate the level of serum bicarbonate (HCO3-) on the electrolytes.