Pediatric Coding Alert

Condition Spotlight:

Clean Up Your Comprehension Surrounding Bronchitis Coding

Published on Thu Mar 07, 2024

See when it’s appropriate to report an unspecified code.

If there is one thing that pediatric offices see consistently throughout winter and spring, it’s upper respiratory infections. Sometimes, though, that cough and cold moves into the chest, and that’s when you have to start moving into the bronchitis and bronchiolitis code sets.

If you find yourself mixing up these two conditions, here is a comprehensive review to help you out.

Distinguish Between Acute and Chronic Bronchitis

Condition refresh: Bronchitis is the inflammation of the mucus membrane in the lungs and bronchial passages. The respiratory disease causes the irritated membrane to swell, get thicker, and narrow or close the airways. This can cause the patient to cough, experience shortness of breath, and expectorate the phlegm. Though similar, try to not confuse this with bronchiolitis, which affects the bronchioles, which are the smaller airways that branch off from the bronchi. It is most common in children under 2 years old and is usually caused by a virus.

Acute: Patients typically develop acute bronchitis because of a viral infection. Acute bronchitis typically lasts for several weeks.

Chronic: Chronic bronchitis is a condition where the patient experiences a cough and mucus most days for at least three months in a year, and for two consecutive years. While cigarette smoking is one of the main causes of chronic bronchitis, several factors and comorbidities can contribute to the condition, including:

Asthma
Pulmonary emphysema
Tuberculosis
Pulmonary fibrosis

Patients with chronic bronchitis can experience an acute exacerbation of their chronic condition, which is diagnosed as acute on chronic bronchitis.

Reminder: You’ll assign acute or chronic condition codes based on the provider’s documentation, since the ICD-10 code set doesn’t provide definitions for acute or chronic conditions.

Consider Simple Versus Mucopurulent

When you search for bronchitis in the ICD-10 Alphabetic Index, you’ll come to Bronchitis > chronic > simple or Bronchitis > chronic > mucopurulent. The listings direct you to the J41.- code category (Simple and mucopurulent chronic bronchitis), which features codes dedicated to simple bronchitis and mucopurulent bronchitis diagnoses. Here’s what each of those conditions entails.

Simple chronic bronchitis: Patients suffering from simple chronic bronchitis, coded to J41.0 (Simple chronic bronchitis), experience frequent coughing with clear secretions. Patients with bronchitis may experience shortness of breath, but patients with simple chronic bronchitis do not, even though the bronchi are narrowed.

Mucopurulent bronchitis: If the physician diagnoses the patient with mucopurulent chronic bronchitis, then you’ll assign J41.1 (Mucopurulent chronic bronchitis). “Mucopurulent chronic bronchitis is differentiated from simple chronic bronchitis in that mucopurulent bronchitis is a type of bronchitis that produces pus in addition to mucus,” says JoAnne Wolf, RHIT, CPC, CEMC, coding manager for Children’s Health Network in Edina, Minnesota. Sputum associated with mucopurulent chronic bronchitis may be described as somewhat thicker and cloudy or opaque in appearance. The sputum may also become darker with a hint of yellow or green if an infection causes sputum production.

Note: It’s also possible for a patient to have simple and mucopurulent chronic bronchitis, which codes to J41.8 (Mixed simple and mucopurulent chronic bronchitis).

Don’t Be Afraid of an Unspecified Code

There are, indeed, many specific codes to choose from, but sometimes an unspecified code is the best choice.

Let’s say an 11-year-old patient presents with a nagging cough, sputum production, shortness of breath (SOB), wheezing, and fatigue. After a thorough physical exam and chest X-rays, the physician diagnoses the patient with acute bronchitis with bronchospasm.

For this condition, you’ll assign J20.9 (Acute bronchitis, unspecified). That’s because acute bronchitis with bronchospasm is listed as one of the included conditions under parent code J20.- (Acute bronchitis) and all the other codes in this group specify a causal connection between the bronchitis and a specified organism. As the pediatrician has not indicated a cause for the bronchitis in this encounter, the unspecified code is your best bet to document the patient’s condition.

Understand the Bronchiolitis Codes and How to Use Them

Earlier, we noted that bronchitis and bronchiolitis are different conditions that affect a different anatomical area. But patient age is also important for assigning the correct code to the diagnosis. “The age of onset of bronchitis and bronchiolitis is different in that bronchiolitis is an infant to early childhood illness, while bronchitis is never seen in this age range but is more likely seen in teens and adults,” according to Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico.

So, let’s say the pediatrician diagnoses an infant with chronic bronchiolitis. The documentation also states that the father, who also lives in the home, is a smoker. As far as coding goes, you should bypass J20.-, J40 (Bronchitis, not specified as acute or chronic), J41.-, or J42 (Unspecified chronic bronchitis) in favor of either J21.- (Acute bronchiolitis) or J44.- (Other chronic obstructive pulmonary disease).

Coding alert: For acute cases caused by infectious agents, you don’t need to include a code from Chapter 1: Certain Infectious and Parasitic Disease (A00-B99). This is because the acute bronchitis and bronchiolitis code sets contain specific codes that include this information. For example, B97.4 (Respiratory syncytial virus as the cause of diseases classified elsewhere) would not be needed if you’re reporting J21.0 (Acute bronchiolitis due to respiratory syncytial virus) or J20.5 (Acute bronchitis due to respiratory syncytial virus).

Add These Codes as Appropriate

Whether you’re reporting bronchitis or bronchiolitis, you’ll need to use an additional code per the instructional note for Chapter 10, Diseases of the respiratory system (J00-J99). This note requires you to identify a patient’s tobacco use and/ or exposure. In this case, if the pediatrician’s documentation indicates it, you will add P96.81 (Exposure to (parental) (environmental) tobacco smoke in the perinatal period) for the father’s smoking. And even though the code stipulates exposure to environmental tobacco smoke, you could also add Z77.22 (Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic)) as both codes have reciprocal Excludes2 instructions allowing you to code them both if appropriate.