ED Coding and Reimbursement Alert

Question: We had a patient come in with bronchitis and the physician didn’t specify the type, so we reported acute bronchitis. But when the claim was audited, we were told that based on their review of the x-ray and the notes, the patient actually had chronic bronchiolitis. How would we know how to code the difference?

Codify Subscriber

Answer: Considering bronchitis is such a common condition that ED physicians see, coding it is far from easy. Look it up in the ICD-10 index, and not only will you find a number of similar-sounding conditions, such as bronchiolitis, but the sheer variety of sub terms in the index can easily lead to coding confusion.

In one sense, bronchitis coding is easy once you locate the acute and chronic codes, and the codes associated with the condition when it is neither acute nor chronic. Simply put, the acute codes can be found in the J20.- (Acute bronchitis) code set. If your provider documents anything else, then you’ll either need to go J40 (Bronchitis, not specified as acute or chronic), J41.- (Simple and mucopurulent chronic bronchitis), or J42 (Unspecified chronic bronchitis) to locate the correct codes.

The acute bronchitis codes are then easily narrowed down by the virus that causes the condition. So, you’d code bronchitis brought on by strep as J20.2 (Acute bronchitis due to streptococcus), while the common cold can bring on J20.6 (Acute bronchitis due to rhinovirus).

Coding the chronic form of the condition, however, is a little more complex despite the fact that there are fewer code choices. First, you need to pay attention to the numerous notes for each of the conditions that direct you to use additional codes involving current or historic tobacco use or tobacco exposure.

Second, you also need to know how to translate your physician’s notes if the patient is documented with mucous hypersecretion, or mucopurulence. This condition, where the patient secretes greater than usual amounts of mucous, can be coded in several different ways with the J41.- codes and, if it leads to obstructing the patient’s airways, could even lead you to use a code from J44 (Other chronic obstructive pulmonary disease).

Coding for bronchitis can also look more complex when you turn to the ICD-10 index. Here, there are two conditions listed that are age-specific. The entries for bronchitis ⇒ with tracheitis and bronchitis ⇒ catarrhal direct you to code J40 (Bronchitis, not specified as acute or chronic) if the patient is 15 years old or above, and J20.9 (Acute bronchitis, unspecified) if the patient is under 15. Although the codes themselves don’t refer to the ages, the index does, which confirms that you should always use a two-step process when selecting a diagnosis – checking both the index and the code listing.

Another index entry, bronchitis ⇒ under 15 years of age, directs you to choose a code from J20.- (Acute bronchitis), while a subentry under this entry directs you code chronic bronchitis as chronic bronchitis, which would direct you to code either J41.- (Simple and mucopurulent chronic bronchitis) or J42 (Unspecified chronic bronchitis).

When differentiating bronchitis from bronchiolitis, keep in mind that the main difference between the two terms depends upon the anatomical area of the lungs that is infected. The bronchioles are the small, delicate airways that lead directly to the alveoli, which are the microscopic “cul-de-sacs” of the lung tree, whereas the bronchi are the larger “pipes” that make up the first two to three branches of the lungs immediately after the trachea.

So, while a diagnosis of bronchitis would lead you to choose from J20.-, J40, J41.- or J42, a bronchiolitis diagnosis would lead you to either J21.- (Acute bronchiolitis) or J44.- (Other chronic obstructive pulmonary disease) in the case of chronic bronchiolitis.