Conquer 5 COPD Coding Pitfalls With This Handy Guide
Remember to identify contributing factors. Pulmonology coders like yourself see a fair share of patient records with chronic obstructive pulmonary disease (COPD) diagnoses. However, this condition comes with its own obstacles that can trip up your daily workflow. Regardless of whether it’s your first day on the job or you’ve been coding for decades, understanding the J44.- (Other chronic obstructive pulmonary disease) code family is critical to compliant coding. Read on to recognize common pitfalls to COPD coding and learn how to avoid the traps. Pitfall 1: Defaulting to the Unspecified COPD Code Both new and experienced pulmonology coders may lean toward selecting J44.9 (Chronic obstructive pulmonary disease, unspecified) to code COPD without any additional details listed in the documentation. Several reasons exist as to why the documentation could be missing this important information, including: Code J44.9 shouldn’t be your go-to COPD code choice if more information can be gleaned from the patient’s record. What’s the fix? Remember, ICD-10-CM guidelines instruct you to use unspecified codes “when the information in the medical record is insufficient to assign a more specific code.” If you encounter a case where the only code choice would be J44.9, you can open a dialogue with the provider. Query the pulmonologist for additional information that will help further specify the type of COPD. Pitfall 2: Ignoring Parent Code Notes The J44.- code category features several coding notes that provide instructions to ensure your claim is compliant. An Includes note under J44.- lists multiple conditions that are coded under the category, including: An Excludes2 note lists several conditions that will be coded alongside the applicable COPD code. According to the ICD-10-CM guidelines, an Excludes2 note means “the condition excluded is not part of the condition represented by the code,” but the Excludes2 condition and the coded condition may exist in the patient at the same time. The codes and associated conditions listed under the Excludes2 note are as follows: Lastly, parent code J44.- has a Code also note instructing you to report an applicable asthma code, if needed. What’s the fix? Review the physician’s documentation carefully to ensure the documented diagnoses don’t go unnoticed. The pulmonologist might make a definitive diagnosis that doesn’t specify “chronic obstructive pulmonary disease” or “COPD.” Remembering the diagnoses listed under the Includes note will remind you to use an applicable J44.- code if the physician’s documented diagnosis matches any condition listed under the note. At the same time, not coding documented conditions the patient is experiencing along with COPD could lead to incorrect treatment. Don’t forget to report conditions listed under the Excludes2 note if the physician documents that the condition and COPD are occurring simultaneously. Plus, in the event that the patient is also living with a type of asthma listed in the J45.- (Asthma) category, you’ll follow the J44.- Code also note instructions to report the type of asthma the patient has. Pitfall 3: Confusing ‘Infection’ and ‘Exacerbation’ The J44.- code category includes two codes that have descriptors that could easily confuse coders: Note that you’ll use J44.0 for a case of COPD with an acute lower respiratory infection, whereas J44.1 is assigned for an exacerbation of COPD. According to ICD-10-CM Official Guidelines, Section I.C.10.a.1, “An acute exacerbation is a worsening or decompensation of a chronic condition.” The guidelines continue to explain that an exacerbation isn’t the same as an infection on a chronic condition, like COPD, but an infection can cause an exacerbation. What’s the fix? Review the encounter notes and look for words that would indicate either an infection (for example, virus, bacteria) or an exacerbation (for example, worsening, aggravation, flare-up). If the documentation and pathology report confirms a viral or bacterial infection, then you’ll assign J44.0 as well as a code for the infection. On the other hand, if the physician confirms that the patient was experiencing a flare-up of their COPD, then you’ll use J44.1. Code J44.1 also features an Excludes2 note that instructs you to assign J44.0 if the patient is also experiencing COPD with acute bronchitis or any applicable conditions listed under the lung diseases due to external agents code range, from J60 (Coalworker’s pneumoconiosis) to J70.- (Respiratory conditions due to other external agents). Pitfall 4: Reporting ‘Other’ or ‘Unspecified’ COPD Without Definitive Dx A patient may initially present to your pulmonology clinic with symptoms of COPD, such as wheezing, coughing, or shortness of breath. In those cases, the pulmonologist will take the necessary steps to diagnose the patient. The physician will review the patient’s history, perform a physical examination, and order imaging or PFT examinations before making a definitive diagnosis. It’s important in this time period before a diagnosis is documented in the patient’s record not to report a COPD code, even if it’s J44.9 or J44.89 (Other specified chronic obstructive pulmonary disease). What’s the fix? According to the ICD-10-CM Official Guidelines, I.B.4, it is acceptable to use codes describing signs and symptoms “when a related definitive diagnosis has not been established (confirmed) by the provider.” This means that until the patient’s record has a specific diagnosis documented, you’ll assign any of the following codes for the recorded symptoms the patient exhibited at the encounter: Pitfall 5: Forgetting to Identify Other Factors While the COPD codes don’t feature a Use additional code note instructing you to report codes that relate to tobacco use, history, dependence, or exposure, you should still include the applicable codes if the information is in the record. This information helps paint the entire picture of what happened that led to the patient’s current condition and can aid in managing future care. What’s the fix? Remember to code as specifically as possible to ensure your claim accurately represents the patient’s condition. Example: A patient living with COPD presents to the pulmonologist with an acute exacerbation of their condition. The patient let the physician know that they recently visited their sister, who smokes a pack of cigarettes a day. The provider diagnoses the patient with an acute exacerbation of their COPD due to the second-hand smoke exposure. In this example, you’ll assign J44.1 for the COPD with exacerbation and Z77.22 (Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic)) to report the exposure to second-hand smoke. Mike Shaughnessy, BA, CPC, Production Editor, AAPC
