Question: I have a medical report for an encounter with an established patient. The pulmonologist documented that the patient has both chronic obstructive pulmonary disease (COPD) and simple chronic bronchitis.
Can you help me determine which diagnosis codes to report?
Pennsylvania Subscriber
Answer: This is a unique situation where we need to examine the Excludes notes for each condition.
Parent code J44.- (Other chronic obstructive pulmonary disease) features an Excludes1 note instructing you to not report J41.- (Simple and mucopurulent chronic bronchitis) codes with J44.- codes. Remember that ICD-10-CM official guidelines say that Excludes1 notes mean the two listed conditions cannot be reported together.
On the other hand, parent code J41.- has an Excludes2 note that includes J44.-. This means that you may report a simple chronic bronchitis diagnosis and a chronic obstructive bronchitis diagnosis on the same report if the conditions are occurring at the same time.
Assign J41.0 (Simple chronic bronchitis) as the primary diagnosis to show the reason for the visit, and then report an appropriate J44.- code, such as J44.9 (Chronic obstructive pulmonary disease, unspecified) to indicate the patient has COPD.
Mike Shaughnessy, BA, CPC, Development Editor, AAPC
