Pulmonology Coding Alert

Find out if you need cause codes.

Acute bronchitis typically manifests due to the presence of a viral infection in the patient. The condition may occur without warning, but you can be prepared to accurately report acute bronchitis encounters with this coding refresher.

Learn how to identify the correct acute bronchitis codes and when to report additional conditions.

Break Down an Acute Bronchitis Diagnosis

Bronchitis, a condition where the bronchi become inflamed, can be either acute or chronic. While chronic bronchitis progresses over time and is usually the product of continual inflammation or irritation from external forces, such as smoking, acute bronchitis develops suddenly from a respiratory infection or a cold.

Acute bronchitis, commonly referred to as a chest cold, has several symptoms that manifest in the patient, including fatigue, shortness of breath, chest discomfort, cough, and sputum (mucus) production.

Typically, acute bronchitis is caused by the same viruses that cause the flu and colds, but other viruses can contribute to an acute bronchitis infection.

Examine the J20.- Code Category

When the pulmonologist diagnoses the patient with acute bronchitis, you’ll turn to the J20.- (Acute bronchitis) code category. The codes in the category require a 4th character, which means you’ll need an additional character to complete the code that represents the documented diagnosis.

In the ICD-10-CM code set, the 4th character options for J20.- are 0 through 8 to indicate the viral infection causing the acute bronchitis with 9 reserved for unspecified acute bronchitis. Below are the completed acute bronchitis codes with the causal infection, which must be documented in the patient’s record to back up your code selection:

• J20.0 (Acute bronchitis due to Mycoplasma pneumoniae)
• J20.1 (Acute bronchitis due to Hemophilus influenzae)
• J20.2 (Acute bronchitis due to streptococcus)
• J20.3 (Acute bronchitis due to coxsackievirus)
• J20.4 (Acute bronchitis due to parainfluenza virus)
• J20.5 (Acute bronchitis due to respiratory syncytial virus)
• J20.6 (Acute bronchitis due to rhinovirus)
• J20.7 (Acute bronchitis due to echovirus)
• J20.8 (Acute bronchitis due to other specified organisms)

You’ll assign J20.8 if the provider documents an acute bronchitis diagnosis that is a result of infection that cannot be attributed to any of the J20.0-J20.7 codes. For example, according to AHA ICD-10 Coding Clinic, Volume 8, Issue 1, “For a patient with acute bronchitis confirmed as due to COVID-19, assign codes U07.1 (COVID-19), and J20.8.”

At the same time, you’ll use J20.9 (Acute bronchitis, unspecified) for an acute bronchitis diagnosis where the pulmonologist doesn’t provide additional details on the infection. However, it wouldn’t hurt to request more information before assigning J20.9 on your claim.

“Query the provider if ‘bronchitis’ is documented without explanation, so that the condition can be reported as an acute infective disorder, including infective agent, or as a chronic disorder,” explains Sheri Poe Bernard, CPC, CRC, CDEO, CCS-P, of Granite GRC Consulting in Salt Lake City, Utah.

Identify Included Conditions

Parent code J20.- features Includes, Excludes1, and Excludes2 notes that apply to every code listed within the category. An Includes note lists all applicable diagnoses that can be reported using the attributed code.

You’ll assign an appropriate J20.- code when the pulmonologist diagnoses the following conditions:

• Acute and subacute bronchitis (with) bronchospasm
• Acute and subacute bronchitis (with) tracheitis
• Acute and subacute bronchitis (with) tracheobronchitis, acute
• Acute and subacute fibrinous bronchitis
• Acute and subacute membranous bronchitis
• Acute and subacute purulent bronchitis
• Acute and subacute septic bronchitis

Remember to Review Excludes1 Notes

According to the ICD-10-CM Official Guidelines, an Excludes1 note “indicates that the code excluded should never be used at the same time as the code above the Excludes1 note.” In other words, the conditions listed under the Excludes1 note aren’t coded with the code you’re assigning.

For example, if you’re assigning a J20.- code, then you cannot also assign J40 (Bronchitis, not specified as acute or chronic). The Excludes1 note under J20 references the following conditions, which are covered by J40:

• Bronchitis [not otherwise specified (NOS)]
• Tracheobronchitis NOS

Also, both conditions listed above are additional synonyms for J40.

Know That Excludes2 Doesn’t Necessarily Exclude Codes

While Excludes1 notes instruct you that the listed code or codes cannot be used with the code you’re assigning, an Excludes2 note allows you to report multiple conditions if the provider documents the patient is experiencing the conditions simultaneously.

According to the ICD-10-CM Official Guidelines, the 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.”

For example, a patient who suffers from chronic simple bronchitis may experience a bout of acute bronchitis caused by a streptococcus infection. In this case, you’d assign J20.2 and J41.0 (Simple chronic bronchitis) since both conditions exist at the same time.

In addition to J41.0, the Excludes2 note under J20.- also features the following codes:

• J41.1 (Mucopurulent chronic bronchitis)
• J42 (Unspecified chronic bronchitis)
• J44.- (Other chronic obstructive pulmonary disease)
• J44.0 (Chronic obstructive pulmonary disease with (acute) lower respiratory infection)
• J45.909 (Unspecified asthma, uncomplicated)
• J47.0 (Bronchiectasis with acute lower respiratory infection)
• J68.0 (Bronchitis and pneumonitis due to chemicals, gases, fumes and vapors)

Sort out This Coding Scenario

Scenario: An 8-year-old patient presents to the pulmonologist with a harsh and productive cough with mucus, fatigue, shortness of breath, and chest pain from coughing. The patient’s pediatrician diagnosed the patient with respiratory syncytial virus (RSV) following a positive nasal swab test. After performing a physical examination and reviewing the patient’s history, the pulmonologist diagnosed the patient with acute bronchitis as caused by the RSV infection.

For this scenario, you’ll assign J20.5 to report the patient’s diagnosis. The pulmonologist diagnosed the patient with acute bronchitis due to the current RSV infection. You don’t need an additional code for the RSV infection because J20.5 is a combination code that indicates the diagnosis and the manifestation.