Primary Care Coding Alert

Once you’ve answered the quiz questions, compare your answers with the ones provided below:

Answer 1: Because bronchitis and bronchiolitis seem similar, they can cause problems for even the most experienced coders. The key to differentiating between the two lies in understanding where the infection that is causing the condition is located in the lungs.

“The bronchioles are the small, delicate airways that lead directly to the alveoli, which are the microscopic ‘cul-de-sacs’ of the lung tree, whereas the bronchi are the larger ‘pipes’ that make up the first two to three branches of the lungs immediately after the trachea,” explains Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico.

Finding a code for chronic bronchiolitis is even trickier, as you won’t find it among the J21.- (Acute bronchiolitis) codes. Instead, the ICD-10 index directs you to J44.9 (Chronic obstructive pulmonary disease, unspecified).

Pro Coding Tip 1: “The age of onset of these diseases 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. Adults rarely have bronchiolitis unless it is associated with an infection or an inhalation injury,” Witt cautions. Regardless of the patient’s age, however, the deciding factor in choosing a code will always be your provider’s documentation.

Answer 2: If your provider documents bronchitis with tracheitis, the ICD-10 index directs you to two different codes: J40 (Bronchitis, not specified as acute or chronic) and J20.9 (Acute bronchitis, unspecified). The difference between them lies in the patient’s age. The index directs you to use J40 if the patient is 15 years of age and above, while J20.9 should only be used for a patient who is under 15 years of age. If the bronchitis with tracheitis is chronic, then the ICD-10 index directs you to J42 (Unspecified chronic bronchitis), which includes chronic bronchitis not otherwise specified, chronic tracheitis, and chronic tracheobronchitis.

Pro Coding Tip 2: A similar entry in the ICD-10 index directs you to use the same codes for catarrhal bronchitis for patients under 15 and patients 15 and over. So, as a rule of thumb, “if the patient is under 15 years of age, the index points you to acute bronchitis, and if the patient is over 15 years of age, you are directed to bronchitis not specified as acute or chronic,” says JoAnne M. Wolf, RHIT, CPC, CEMC, AAPC Fellow, coding manager at Children’s Health Network in Minneapolis.

Answer 3: One way to understand why ICD-10 assigned the code for tracheobronchitis the way that it did is to understand the guideline that starts out Chapter 10. Specifically, the note states “when a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site.” The note goes on to provide tracheobronchitis as an example, assigning it a code of J40 — one of the chronic lower respiratory disease codes (J40-J47).

Answer 4: “Because we have codes for acute bronchitis caused by specific infectious agents, codes from Chapter 1 are not needed,” says Wolf. “Acute bronchitis due to RSV is coded solely as J20.5 [Acute bronchitis due to respiratory syncytial virus]. Since the infection is specified in J20.5, B97.4 [Respiratory syncytial virus as the cause of diseases classified elsewhere] is not needed,” Wolf elaborates.

Pro Coding Tip 3: All the J20.- (Acute bronchitis) codes include the infectious agent causing the bronchitis with the exception of the unspecified code J20.9 (Acute bronchitis, unspecified). Consequently, there is no “Use additional code” instruction for this code group.

However, if your provider documents any other kind of bronchitis with a code from J40, J41 (Simple and mucopurulent chronic bronchitis), or J42 (Unspecified chronic bronchitis), or with J45.909 (Unspecified asthma, uncomplicated) for allergic bronchitis or J45.90- (Unspecified asthma) for asthmatic bronchitis, you will need to use an additional code that describes the patient’s tobacco use or dependence, history of tobacco use, or exposure to tobacco smoke.