Pulmonology Coding Alert

Find out what separates the J41.- conditions.

If a pulmonologist’s report describes a patient’s bronchitis diagnosis as “simple,” with a more complex term like “mucopurulent,” or as a combination of the two, you might end up scratching your head as to what to search for in the ICD-10-CM code set. The good news is that the J41.- (Simple and mucopurulent chronic bronchitis) code category contains the principal diagnosis codes you need.

Get to know these unique conditions and how to code the diagnoses.

Separate Chronic from Acute Bronchitis Cases

Before you can dive into the individual J41.- codes, it’s a good idea to take a quick refresher on the differences between acute and chronic bronchitis.

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.

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. In comparison, acute bronchitis typically lasts for several weeks. 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-CM code set doesn’t provide definitions for acute or chronic conditions.

Patients can develop acute bronchitis because of a viral infection, whereas several factors can contribute to chronic bronchitis. Cigarette smoking is one of the main causes of chronic bronchitis, but comorbidities that contribute to the condition include:

• Asthma
• Pulmonary emphysema
• Tuberculosis
• Pulmonary fibrosis

Learn the Difference Between Simple and Mucopurulent Bronchitis

The J41.- code category features codes dedicated to simple bronchitis and mucopurulent bronchitis diagnoses. When you search for the conditions in the ICD-10-CM Alphabetic Index, you’ll look for Bronchitis > chronic > simple or Bronchitis > chronic > mucopurulent to direct you to the correct code choices in the Tabular List.

You’ll assign J41.0 (Simple chronic bronchitis) to report a simple chronic bronchitis diagnosis. When a patient is suffering from simple chronic bronchitis, they’ll 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.

If the pulmonologist diagnoses the patient with mucopurulent chronic bronchitis, then you’ll assign J41.1 (Mucopurulent chronic bronchitis) to report the condition. “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.

Finally, you’ll assign J41.8 (Mixed simple and mucopurulent chronic bronchitis) for cases where the physician diagnoses the patient with simple and mucopurulent chronic bronchitis.

Don’t Forget the Parent Code Notes

Parent code J41.- features an Excludes1 note that instructs you to not assign J42 (Unspecified chronic bronchitis) or any of the J44.- (Other chronic obstructive pulmonary disease) codes with your specific J41.- code. The Excludes1 note indicates that the specified code conditions cannot occur at the same time as your J41.- condition.

You’ll also need to assign tobacco-related codes if the provider’s documentation includes that information. “Because chronic bronchitis is most often caused by cigarette smoking, it is important to also code for tobacco dependence or use, exposure to tobacco smoke, or history of tobacco dependence,” Wolf adds.

You’ll assign the following codes to identify a patient’s involvement with tobacco:

• Z77.22 (Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic))
• P96.81 (Exposure to (parental) (environmental) tobacco smoke in the perinatal period)
• Z87.891 (Personal history of nicotine dependence)
• Z57.31 (Occupational exposure to environmental tobacco smoke)
• F17.- (Nicotine dependence)
• Z72.0 (Tobacco use)

Examine the scenario below to learn how to sequence the codes correctly.

Scenario: An established patient presents to your pulmonology practice with a cough that produces clear secretions and chest discomfort. The patient has experienced the symptoms for several months. The patient currently smokes two packs of cigarettes a day and has failed to quit several times. After testing, the physician diagnoses the patient with simple chronic bronchitis.

You’ll need to assign two ICD-10-CM codes for this scenario. First, you’ll assign J41.0 to report the simple chronic bronchitis diagnosis. Next, you’ll assign F17.210 (Nicotine dependence, cigarettes, uncomplicated) to report the patient’s cigarette smoking habit. The 5th character “1” indicates the patient’s dependence on cigarettes, and the 6th character “0” shows the patient’s inability to stop using cigarettes and that the condition isn’t complicated by other factors like cigarette withdrawal or other nicotine-induced disorders.

Identify the Diagnostic Testing Codes

A provider has several options available to evaluate a patient for bronchitis. In addition to a complete health history, “a provider may order a chest x-ray, lung computed tomography (CT) scan, arterial blood gas, or pulmonary function tests (PFTs), such spirometry, to diagnosis chronic bronchitis,” Wolf says.

If your provider opts for a chest X-ray or CT scans, you’ll explore the radiology section of codes in the CPT^® code set. Depending on the number of views and the imaging modality, you’ll assign codes from the 71045-71048 (Radiologic examination, chest …) or 71250-71270 (Computed tomography, thorax, diagnostic …) ranges for the imaging studies.

You’ll assign 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation) or 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) if the provider performed PFTs to assess the patient’s condition.