Home Health ICD-9/ICD-10 Alert

Question:

I understand that in home health, we should list 491.21 (Obstructive chronic bronchitis with [acute] exacerbation) if a patient's chronic obstructive pulmonary disease (COPD) is stated as decompensated, exacerbated, or end-stage. My question is in regard to hospice coding. Specifically, should we automatically assign 491.21 when COPD is documented as the terminal diagnosis, or should we only list this code if the COPD is documented as "end-stage"?

New York Subscriber

Diagnosis code 496 (Chronic airway obstruction, not elsewhere classified) is a nonspecific code that should only be used when the documentation in a medical record does not specify the type of COPD being treated.

If COPD is a terminal diagnosis, the logical conclusion -- because the physician is certifying that the terminal illness will likely result in death in six months or less -- is that the COPD is more than "Not otherwise specified."

In situations such as the one you describe, listing 491.21 would be appropriate. You could also ask the physician for a statement regarding decompensated or end stage to support your terminal diagnosis.