Pulmonology Coding Alert

Hint: Signs and symptoms codes might suit some cases best.

Chronic obstructive pulmonary disease (COPD) is one of the most common diagnoses that respiratory physicians see, but that doesn’t mean coding for this condition is simple. To ensure you’re reporting your COPD visits properly, employ these important steps.

1. Understand What COPD Is

To understand how to code COPD correctly, you first need to make sure you know exactly what it is. COPD is “is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma,” according to the COPD Foundation (Source:  www.copdfoundation.org/What-is-COPD/Understanding-COPD/What-is-COPD.aspx).

Unfortunately, this can make it challenging for a coder to know whether to report COPD or the other progressive lung diseases separately or as one code. Differentiating between emphysema and chronic bronchitis would require lung function studies, blood gases, and X-rays. However, if there is a long history of cigarette smoking, which is the primary cause of COPD in the United States, the physician is likely to suspect COPD at the first visit after listening to the lungs and taking a complete history.

2. Report Signs and Symptoms When There’s No Definitive Dx

Initially, the patient may only present with a cough or shortness of breath. In this case, you should record symptoms as they appear in the medical record, which might include R06.02 (Shortness of breath), R06.2 (Wheezing), and/or R05 (Cough).

But if COPD is the definitive diagnosis and stipulated by the provider in the medical record, coding for this situation would require a code from the J44 (Other chronic obstructive pulmonary disease) code category. That means starting your search with J44.9 (Chronic obstructive pulmonary disease, unspecified) although that may not be the only code you might use.

3. Understand When to Use J44.9 Alone

This code is reserved for cases where the provider has indicated a diagnosis of COPD but has not listed the cause, such as chronic bronchitis or emphysema. In other words, you should reserve the use of J44.9 for circumstances when your provider does not document associated manifestations, conditions, or exacerbations.

4. Pay Attention to Related Conditions

You’ll find that many COPD patients have associated conditions. Check out the following to determine how to select the right codes for these situations.

COPD-related asthma: If your provider documents both COPD and COPD with acute asthma exacerbation, for example, then you should code J44.9 for the COPD along with J45.901 (Unspecified asthma with (acute) exacerbation) for the acute exacerbation of the asthma.

COPD with pneumonia: If both COPD and pneumonia are present, assign J44.9 with J18.9 (Pneumonia, unspecified organism) unless your provider documents another related cause. Depending on the reason for the visit, either diagnosis may be sequenced first.

COPD with acute bronchitis: Here, you’ll code J44.0 (Chronic obstructive pulmonary disease with acute lower respiratory infection) first. Then, following the “Code Also” note that accompanies the code, which states “Code also to identify the infection,” you’ll chose a code from the J20.- (Acute bronchitis) category, using J20.9 (Acute bronchitis, unspecified) if your pulmonologist does not specify the infectious agent.

COPD with emphysema: If your provider documents COPD, or COPD with exacerbation and emphysema, only the emphysema is reported, leading you to the J43 (Emphysema) codes if your provider documents these particular conditions. This is because there’s an Excludes1 note under J44 that references emphysema without chronic bronchitis (J43.-), which means the two conditions are mutually exclusive from an ICD-10 perspective.

However, if COPD, emphysema, and chronic bronchitis are all documented, then only assign J44.9 for the COPD, since a corresponding Excludes1 note under J43 refers ICD-10 users to J44 for emphysema with chronic (obstructive) bronchitis.

5. Don’t Forget to Include Additional Codes

Finally, as the COPD Foundation emphasizes, genetics aside, most cases of COPD are caused by inhaling pollutants. These include “tobacco smoking (cigarettes, pipes, cigars, etc.) … second-hand smoke … [and] fumes, chemicals and dust found in many work environments.”

So, where applicable, you will code:

• F17.- (Nicotine dependence)
• Z57.31 (Occupational exposure to environmental tobacco smoke)
• Z72.0 (Tobacco use)
• Z77.22 (Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic))
• Z87.891 (Personal history of nicotine dependence).

You should also remember to code Z99.81 (Dependence on supplemental oxygen) if the patient is on long-term oxygen therapy for the condition.