Pulmonology Coding Alert

COPD is a disease that causes obstructed airflow in the lungs. This chronic inflammatory disease is caused by prolonged exposure to irritants, which usually includes cigarette smoke. Patients who are diagnosed with COPD face an increased risk of developing lung cancer, heart disease, and other conditions. Two conditions that usually occur together and can contribute to COPD are chronic bronchitis and emphysema.

Patients may experience symptoms such as high fever, fatigue, cough, weakness, and shortness of breath. Considered a progressive disease, COPD gets worse over time, but the condition can be treated.

Choose the Correct COPD Code for the Diagnosis

The ICD-10-CM code set features three COPD codes under the parent code J44.- (Other chronic obstructive pulmonary disease), which include:

• J44.0 (Chronic obstructive pulmonary disease with (acute) lower respiratory infection)
• J44.1 (Chronic obstructive pulmonary disease with (acute) exacerbation)
• J44.9 (Chronic obstructive pulmonary disease, unspecified)

However, knowing which COPD code to assign can be tricky if you have issues in the physician’s report. “The biggest problem that I find is that COPD will be listed in the Assessment/Plan but without any supporting documentation, such as the status isn’t documented, medications aren’t being linked to the condition. Basically, nothing to support M.E.A.T.,” says Julie Davis, CPC, CRC, COC, CPMA, CDEO, CPCO, Approved Instructor, risk adjustment manager at Physician Health Partners and adjunct instructor with the AAPC Virtual Instructor Led Training (VILT) program, from Denver, Colorado. For an explanation of the M.E.A.T. approach to documentation, see the

“Know What Makes the M.E.A.T. of Documentation” section of this article.

Or, to put it another way, “Differing details on specificity can affect accurate code capture,” says Denae Merrill, CPC, CDEO, CRC, RADV (risk adjustment data validation) project and training manager in Michigan, expressing a similar issue regarding provider documentation.

Making sure the provider’s documentation contains all the necessary information you need to correctly code the patient’s COPD is crucial. This is important since parent code J44.- carries multiple conditions in the Includes note, features a Code also note to specify the type of asthma, if applicable, and instructs you to report exposure to, dependence on, or use of tobacco.

Pay Attention to Parent Code Instructions

Parent code J44.- features an Includes note that allows you to use J44.- for several diagnoses, including, but not limited to, asthma with COPD, chronic asthmatic (obstructive) bronchitis, chronic bronchitis with airway obstruction, chronic bronchitis with emphysema, and chronic obstructive bronchitis.

At the same time, J44.- features an Excludes1 note that prevents the following codes from being reported in conjunction with the COPD code:

• J41.- (Simple and mucopurulent chronic bronchitis)
• J42 (Unspecified chronic bronchitis)
• J43.- (Emphysema)
• J47.- (Bronchiectasis)

While J42’s descriptor is “Unspecified chronic bronchitis,” synonyms for the code are listed in the Excludes1 note for J44.-. These synonyms include chronic bronchitis NOS, chronic tracheitis, and chronic tracheobronchitis.

Separate Exacerbation From Infection

You’ll assign J44.1 to code a patient’s diagnosis when they presented experiencing an acute exacerbation of their COPD. According to the ICD-10-CM Official Guidelines, Section I.C.10.a.1, “An acute exacerbation is a worsening or a decompensation of a chronic condition. An acute exacerbation is not equivalent to an infection superimposed on a chronic condition, though an exacerbation may be triggered by an infection.”

The descriptors for J44.0 and J44.1 include the terms “infection” and “acute exacerbation,” respectively. Does the guideline mean that if a patient experiences an acute exacerbation of COPD, then you cannot code an infection at the same time? “This statement can be both true and false. There are separate ICD-10-CM codes for each of these conditions, but the two seem to be tied together,” Davis says.

While the guideline does state an acute exacerbation isn’t equal to an infection of a chronic condition, it continues to state that the infection may cause the exacerbation.

Example: A patient with COPD is diagnosed with an acute exacerbation of their condition as well as acute bronchitis. If the provider states in their report that the bronchitis is causing the exacerbation of the COPD, then you can correctly assign J44.0, J44.1, and J20.9 (Acute bronchitis, unspecified).

Don’t forget the infection: “Reporting with an infection will require additional code(s) to properly represent the patient’s condition,” Merrill says. Code J44.0 features a Code also note that instructs you to report the infection’s diagnosis code. In the example listed above, J20.9 identifies the bronchitis infection in the patient.

J44.1 Excludes2 note: In addition to the guideline specifying that an infection could cause the exacerbation, J44.0 features an Excludes2 note listing J44.0. This means that you can report J44.1 and J44.0 together if the conditions are occurring at the same time. As ICD-10-CM guidelines, Section I.A.12.b, states, “An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.”

The Excludes2 note also lists the J60-J70 (Lung diseases due to external agents) code range, so you can correctly report conditions such as J60 (Coalworker’s pneumoconiosis), J66.0 (Byssinosis), and J67.0 (Farmer’s lung), if they’re occurring at the same time as the COPD exacerbation. Code J44.9 also features an Excludes2 note that lists J60-J70, so again you should watch for cases where it is appropriate to report the codes together to fully capture the diagnosis.