Home Health ICD-9/ICD-10 Alert

Question: Our new patient was treated by her primary care physician for an acute exacerbation of her asthma. The physician ordered a new inhaler for her asthma. She has a long history of chronic obstructive pulmonary disease (COPD) with oxygen at two liters via nasal cannula, hypertension (HTN) and congestive heart failure (CHF). Her physician has ordered skilled nursing to teach the new inhaler, assess effectiveness of the treatment change and assess for compliance issues. How should we code for this patient?

Oregon Subscriber

Answer: List the following codes for this patient, says Joan L. Usher, BS, RHIA, COS-C, ACE, president, of JLU Health Record Systems in Pembroke, Mass.

• M1020a: 493.22 (Chronic obstructive asthma with acute exacerbation);
• M1022b: 401.9 (Essential hypertension; unspecified);
• M1022c: 428.0 (Congestive heart failure; unspecified).

A single combination code -- 493.22 -- covers both your patient's COPD and her asthma, Usher says. You should assign a combination code only when that code fully identifies the diagnostic conditions involved or when the alphabetic index directs, she says. Don't list multiple codes when you can instead list a single combination code that clearly identifies all of the elements documented in the diagnosis.

Due to the overlapping nature of the conditions that make up COPD and asthma, there are many variations in the way these conditions are documented, Usher says. Choose your codes based on the terms as documented.

Best practice: When selecting the correct code for the documented type of COPD and asthma, make sure to first reference the alphabetic index, and then verify the code in the tabular list, Usher says. There are many instructional notes under the different COPD subcategories and codes. Reviewing all of these notes helps assure that you choose the correct codes. For example, the guidelines and tabular list notes all indicate that a 496 (Chronic airway obstruction, not elsewhere classified) code cannot be reported with a code from 491-493. And the inclusion note under 493.2 states "asthma with COPD."