Home Health ICD-9/ICD-10 Alert

Obstructive chronic bronchitis covers more conditions than you might expect.

Correctly reporting chronic obstructive pulmonary disease (COPD), obstructive bronchitis, and emphysema depends on your understanding the details in the patient's medical record.

Making sure the documentation supports the patient's diagnosis and that you code for any associated acute conditions will ensure that you're correctly reporting pulmonary diagnoses. Here's how to do it:

One area of COPD coding that leaves home care coders scratching their heads is when the patient has a diagnosis like "COPD specified as emphysema exacerbation."

For this patient, look to 491.21 (Obstructive chronic bronchitis; with [acute] exacerbation). Even though the patient may not have chronic bronchitis, you should report 491.21 anyway. This diagnosis code represents a variety of conditions.

For instance, when you look beyond the initial coe descriptor for 491.21 in your ICD-9 manual, you'll see that this ICD-9 code also includes these descriptions:

• acute exacerbation of chronic obstructive pulmonary disease (COPD).

• decompensated chronic obstructive pulmonary disease (COPD).

• decompensated chronic obstructive pulmonary disease (COPD) with exacerbation.

Here's why: Emphysema is a form of COPD commonly associated with bronchitis and chronic bronchitis, says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia. "Because it is difficult to delineate 'pure' cases of emphysema or chronic bronchitis, they are commonly grouped together," she explains.