Pulmonology Coding Alert

Hint: pay attention to the ICD-10-CM code notes.

Chronic obstructive pulmonary disease (COPD) is a condition that affects many pulmonology patients. But if you’re not reporting every diagnosis code that applies, you’re not telling the full story of what is happening with the patient.

Read on to find out what you need to know to keep your COPD coding in excellent shape.

Breathe in This COPD Condition Refresher

COPD is a chronic inflammatory disease that obstructs the airflow in the lungs. Typically, the condition is caused by prolonged exposure to irritants, such as cigarette smoke, air pollution, environmental dust, and chemical fumes.

You’ll turn to the J44.- (Other chronic obstructive pulmonary disease) code category in the ICD-10-CM code set for COPD-related diagnoses.

Be on the lookout: The ICD-10-CM code set features several conditions listed under the Includes note for the J44.- code category. But in order for the condition to be considered COPD, the patient must experience obstructed breathing. However, the documentation won’t always include the word “obstructive” in the condition. So, you won’t just use a J44.- code for chronic obstructive asthma, chronic obstructive bronchitis, chronic obstructive tracheobronchitis, chronic asthmatic (obstructive) bronchitis, and chronic bronchitis with airway obstruction. You’ll also look to the J44.- category when the pulmonologist diagnoses the patient with asthma with COPD, chronic bronchitis with emphysema, or chronic emphysematous bronchitis.

Explore the COPD ICD-10-CM Codes

ICD-10-CM offers several codes for a COPD diagnoses. You’ll select the appropriate code based on the type of COPD, if the patient is experiencing a flare up, or is experiencing another infection as well as identified in the documentation.

For example, you’ll assign J44.0 (Chronic obstructive pulmonary disease with (acute) lower respiratory infection) if the patient has COPD and is experiencing a lower respiratory infection like acute bronchitis. The code set uses a Code also note to instruct you to assign an appropriate code to identify the infection, if known.

On the other hand, if the patient is experiencing an exacerbation or an acute exacerbation of their COPD, then you’ll assign J44.1 (Chronic obstructive pulmonary disease with (acute) exacerbation) to report the diagnosis.

Under the J44.8- (Other specified chronic obstructive pulmonary disease) code subcategory, you’ll find codes to report specific types of COPD. If the pulmonologist diagnoses the patient with bronchiolitis obliterans, bronchiolitis obliterans syndrome, or obliterative bronchiolitis, you’ll assign J44.81 (Bronchiolitis obliterans and bronchiolitis obliterans syndrome) to report the condition.

You’ll assign J44.89 (Other specified chronic obstructive pulmonary disease) to report certain COPD diagnoses that don’t fall under J44.0, J44.1, or J44.81. Conditions reported with J44.89 include chronic asthmatic (obstructive) bronchitis and chronic emphysematous bronchitis, which also are listed under the J44.- parent code’s Includes note.

Carefully Examine the Pulmonologist’s Documentation

Reporting COPD correctly requires careful documentation review. Follow these helpful tips to ensure you’re following the ICD-10-CM code set’s instructions:

Tip 1: Check the provider’s documentation to see if the patient also suffers from a form of asthma. “If the COPD is documented with asthma, you would need to code the type of asthma along with the COPD code,” says Julie Davis, CPC, CRC, COC, CPMA, CPCO, CDEO, AAPC Approved Instructor, risk adjustment manager of Physician Health Partners in Parker, Colorado.

Parent code J44.- features a Code also note that instructs you to assign a code from the J45.- (Asthma) category, if applicable.

Tip 2: Pay attention to other documented conditions. Parent code J44.- features an Excludes1 note that instructs you to not code the listed conditions with an applicable J44.- diagnosis code. For example, if the provider documents a case of chronic bronchitis

NOS and COPD, you’re unable to report J42 (Unspecified chronic bronchitis) and J44.0 together on the same claim.

Tip 3: Know which conditions can be reported together. An Excludes2 under J44.-, J44.1, and J44.9 allows you to report additional conditions with your applicable COPD code if the patient is experiencing the additional conditions and they are documented.

At the same time, J44.0 features a Code also note to instruct you to assign a code that identifies the lower respiratory infection.

Tip 4: Look for the reason for the visit. Bronchiolitis obliterans and bronchiolitis obliterans syndrome, coded to J44.81, is a complication following a transplant. If the provider documents any of the complications or conditions listed under J44.81’s Code first and Code also notes, respectively, then you’ll assign codes to reflect those issues. This is not a requirement if the condition is unknown or not correlated.

Tip 5: When in doubt, query the provider, especially when the provider documents J44.9 (Chronic obstructive pulmonary disease, unspecified) for unspecified COPD conditions without any additional details. Code J44.9 shouldn’t be your default code choice, so you should query the provider for additional information that would further specify the COPD type.