Pulmonology Coding Alert

Find out the difference between J44.1 and J44.9.

Emphysema and chronic bronchitis are two types of chronic obstructive pulmonary disease (COPD) that often coexist. Both conditions leave the patient hard of breathing and exhibiting other lung related symptoms. When the pulmonologist diagnoses a patient with emphysema with chronic bronchitis, you would report the ICD-9 code 491.20 (Obstructive chronic bronchitis without exacerbation).

ICD difference: When ICD-9 becomes ICD-10 on October 1, 2013, you will change 491.20 to J44.9 (Chronic obstructive pulmonary disease, unspecified). This diagnosis will pertain to chronic, irreversible obstruction of air flow from the lungs. ICD-10 J44.9 is an unspecified code that will apply to other COPDs including asthma with chronic obstructive bronchitis, subacute obliterative bronchiolitis, and dyspnea with chronic bronchitis.

Coder tips: Say a pulmonologist treats a new patient with a chronic cough and abnormal sputum. During the encounter, the physician performs a comprehensive history and examination and medical decision-making of low complexity. Then, he makes a diagnosis of obstructive chronic bronchitis without acute exacerbation. How many diagnosis codes should I include on the claim?

Only one ICD-9 code should link to the E/M 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a detailed history; a detailed examination; medical decision-making of low complexity...). You would code the patient's bronchitis with J44.9. If the physician's documentation specifies acute exacerbation, you would report J44.1 (Chronic obstructive pulmonary disease with [acute] exacerbation).