Primary Care Coding Alert

Question: My provider assessed a patient with asthma who was experiencing acute exacerbations twice a week, which was limiting the patient’s activities. The patient uses an inhaler more than twice a week, but not daily. A pulmonary function test (PFT) recorded a forced expiratory volume in 1 second (FEV1) >80%, and the provider diagnosed an acute exacerbation of mild persistent type asthma. I know that I need to use J45.3-, but how do I know which 5th digit to use?

North Dakota Subscriber

Answer: Based on the scenario, J45.31 (Mild persistent asthma with (acute) exacerbation) is the correct diagnosis in this scenario.

Here’s why. Asthma has four different states of severity — intermittent, mild persistent, moderate persistent, and severe persistent — that correspond with the first four codes in the J45.- group:

• J45.2- (Mild intermittent asthma)
• J45.3- (Mild persistent asthma)
• J45.4- (Moderate persistent asthma)
• J45.5- (Severe persistent asthma)

As you’ve noticed, most of the J45.- codes require a 5th character to signify the patient’s current state. Adding a 0 as the 5th character signifies no complications and adding a 1 signifies the patient’s condition is getting worse. Adding a 2 indicates status asthmaticus, which is the most severe form of asthma and is likely to require hospitalization. Your provider documented acute exacerbation, which fits squarely into the requirements for J45.31.

Note: If the provider records the presence of both an acute exacerbation of asthma and status asthmaticus, you want to code to the more serious condition, which is the status asthmaticus.