Pulmonology Coding Alert

Additionally, a patient’s personal history of, exposure to, or dependence on cigarette smoking can be a contributing factor to developing COPD and needs to be documented with the appropriate ICD-10-CM code. A provider is likely to suspect COPD following the first visit after collecting a complete history and auscultating (listening to) the lungs.

2. Select the Correct Codes for Related Conditions

You’ll encounter medical reports where COPD patients have associated conditions. Each situation is different and has unique coding rules for reporting COPD and the condition. Check out the following to learn how to assign the correct codes for the diagnoses.

COPD-related 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, CEMC, AAPC Approved Instructor, senior manager of compliance, Honest Medical Group in Parker, Colorado.

You’ll assign J44.9 (Chronic obstructive pulmonary disease, unspecified) for the COPD and J45.901 (Unspecified asthma with (acute) exacerbation) for the acute exacerbation of the patient’s asthma if the provider documents both COPD and COPD with acute asthma exacerbation.

In this example, parent code J45.- (Asthma) features an Excludes2 note that includes asthma with COPD. An Excludes2 note indicates that two or more conditions may exist at the same time, and you may report the conditions together if the physician has documented them.

COPD with pneumonia: If the physician documents the patient has COPD and pneumonia, then again, you’ll use two codes to report the conditions. Assign J44.9 with J18.9 (Pneumonia, unspecified organism), unless the provider identifies the exact cause of the pneumonia, such as pneumococcal pneumonia which is coded to J13 (Pneumonia due to Streptococcus pneumoniae).

COPD with acute bronchitis: In instances where the provider diagnoses the patient with COPD with acute bronchitis, you’ll start with J44.0 (Chronic obstructive pulmonary disease with (acute) lower respiratory infection), and then follow the Code also note listed under the code. This note instructs you to assign a code to identify the infection. You’ll turn to the J20.- (Acute bronchitis) category and assign the appropriate four-character code to specify the infectious agent. However, if the pulmonologist doesn’t identify the cause of the infection, then you’ll assign J20.9 (Acute bronchitis, unspecified).

COPD with emphysema: When the physician documents the patient’s condition as COPD or COPD with exacerbation and emphysema, you can report the COPD and the emphysema codes together, as of Oct. 1, 2023. In previous years, J43 (Emphysema) featured an Excludes1 note, which included J44.- (Other chronic obstructive pulmonary disease). The Excludes1 note listed the conditions as emphysema with chronic (obstructive) bronchitis and emphysematous (obstructive) bronchitis. An Excludes1 note indicates that the primary code condition and the listed conditions under the note may never be coded together.

However, in the 2024 ICD-10-CM code set, this note has been changed to an Excludes2 note, which means you can report both conditions if the physician documents the conditions are occurring together. Most people with COPD have both emphysema and chronic bronchitis. So, if the physician documents the diagnoses as COPD with emphysema, then you can report J43 and J44.1 together.

3. Apply Additional Codes, When Necessary

Scenario: A patient presents to the emergency department (ED) with respiratory problems. The patient recently underwent a bone marrow transplant. After testing, the physician diagnosed the patient with bronchiolitis obliterans as a complication of the bone marrow transplant.

To report this patient’s diagnoses, you’ll assign T86.09 (Other complications of bone marrow transplant) and J44.81 (Bronchiolitis obliterans and bronchiolitis obliterans syndrome). Let’s examine how these codes are assigned.

Several codes in the J44.- category feature additional notes, such as Includes, Excludes1, and Excludes2 notes. Two other notes that are critical to correctly coding the patient’s conditions are Code first and Code also notes.

Code J44.81 has the following code notes listed underneath it:

• Code first, if applicable
• Code also, if applicable, associated conditions

Starting with the Code first note, you’ll assign a code from the list under the note as the primary diagnosis code if the physician documented the condition. In the scenario above, the provider documented that the bronchiolitis obliterans was a complication of the bone marrow transplant, which lets you know to list T86.09 as the primary diagnosis code. Next, you’ll assign the ICD-10-CM code for the patient’s condition, which in the scenario is J44.81.

If the patient was experiencing another condition that could be related to the bronchiolitis obliterans, then you’d assign an applicable condition from the Code also list following T86.09.

4. Choose Signs/Symptoms Codes Without a Definitive Dx

When the patient initially presents to your pulmonology clinic, they may be experiencing symptoms of COPD, such as shortness of breath, wheezing, or coughing. Without a definitive diagnosis, you can only report these documented symptoms per ICD-10-CM Official Guidelines. If the patient presents with signs or symptoms of COPD, you’ll assign any of the following codes until the pulmonologist makes a diagnosis:

• R06.02 (Shortness of breath)
• R06.2 (Wheezing)
• R05.- (Cough)
• R50.9 (Fever, unspecified)
• R53.1 (Weakness)
• R53.83 (Other fatigue)

However, if the provider documents a COPD diagnosis in the medical record, you’ll assign an appropriate code from the J44.- category.

5. Know When to Select an Unspecified Code

You may encounter situations where the pulmonologist has documented the patient’s diagnosis simply as COPD without listing the cause of the condition, like emphysema or chronic bronchitis. In cases where the physician doesn’t document the COPD’s associated conditions, exacerbations, or manifestations, you’ll only assign J44.9.