Modifier Coding Alert

Four of the seven COPD base code descriptors for ICD-9 are direct matches to ICD-10.

If you are worried about not being able to code a cut and dry case of emphysema in the future, don’t be. The code for a diagnosis of emphysema is a one-to-one ICD-9 to ICD-10 swap. If you have a condition with a complication, keep reading to learn how you will need to report those cases when ICD-10 goes into effect in October.

Notice What Won’t Change

Having a one-to-one relationship between some ICD-9 and ICD-10 codes is an advantage with the chronic obstructive pulmonary disease (COPD) codes.

“With all the specificity needed for ICD-10, looking at these respiratory issues shows that we had the specificity needed for ICD-10 in ICD-9,” says Suzan (Berman Hauptman, MPM, CPC, CEMC, CEDC, director of coding operations at Allegheny Health Network in Pittsburgh, Pa. “For a pulmonologist, the transition from one set to the other will be a smooth transition.”

Some of the COPD codes create a clean crosswalk. For example, if you use 492 (Emphysema) today, with ICD-10 you will use J43 (Emphysema). The asthma codes are one-to-one swaps, too. Code 493 (Asthma) will be J45 (Asthma) later this year.

ICD-9: There are seven base COPD as follows:

• 490 — Bronchitis, not specified as acute or chronic
  
• 491 — Chronic bronchitis
  
• 492 — Emphysema
  
• 493 — Asthma
  
• 494 — Bronshiectasis
  
• 495 — Extrinsic allergic alveolitis
  
• 496 — Chronic airway obstruction, not elsewhere classified.

ICD-10: In the future, you’ll have the following base codes:

• J40 — Bronchitis, not specified as acute or chronic
• J41 — Simple and mucopurulent chronic bronchitis
• J42 — Unspecified chronic bronchitis
• J43 — Emphysema
• J44 — Other chronic obstructive pulmonary disease
• J45 — Asthma
• J47 — Bronchiectasis.

The ICD-9 codes currently expand up to five digits. Under ICD-10, for more specificity in the case of complications, you will need to go out to a fifth or even a sixth character for these base COPD codes.

Example: You will need to report 493.92 (Asthma unspecified with [acute] exacerbation) as J45.901 (Unspecified asthma with (acute) exacerbation) with the transition to ICD-10.

Cope With Separate Diagnosis and Complication Codes

There is some coding confusion when a code excludes a complication. If you have a patient that has COPD with a complication of acute bronchitis, you will use J44.1 (Chronic obstructive pulmonary disease with [acute] exacerbation), but you will also need J20.- (Acute bronchitis, …). There is a possibility that a patient will have COPD and bronchitis.

An issue: Not all experts believe that the transition to ICD-10 for COPD codes will be smooth.

“Even documenting the components of the COPD is morev complicated in ICD-10-CM because the type of emphysema or the type of chronic bronchitis would also need to be included to avoid unspecified codes,” says Cathy Jennings, BS, CPC, CEDC, CHONC, CAPM, managing consultant at Medical Revenue Solutions in Missouri.