Pulmonology Coding Alert

Find out how to code paraseptal emphysema.

Chronic obstructive pulmonary disease (COPD) is a lung disease that makes it difficult for the patient to breathe, and the condition gets worse over time. Emphysema is one of the most severe forms of COPD and the condition takes on several forms depending on how it affects the patient’s respiratory system.

Get to know this distinct condition to learn how to choose the correct diagnosis codes.

Receive an Explanation on Emphysema

Two conditions that can develop over time due to COPD are chronic bronchitis and emphysema. Chronic bronchitis is an inflammation of the bronchi and emphysema is damage to the patient’s lungs. One of the most important points to remember is that the connection between COPD and emphysema is a one-way relationship.

“All emphysema can be classified as COPD, but not all COPD can be classified as emphysema. In ICD-10-CM coding, emphysema is the most specific form of COPD and can be coded alone, unless there are other factors affecting the patient’s condition at the time of the encounter,” explains Carol Pohlig, BSN, RN, CPC, manager of coding and education in the department of medicine at the Hospital of the University of Pennsylvania in Philadelphia.

Recognize the Specific Types of Emphysema

The ICD-10-CM code set lists the emphysema diagnosis codes under the J43.- (Emphysema) code category. This category requires a 4^th character to complete each code, so you can specify the pulmonologist’s documented emphysema type. The J43.- category specifies unilateral, panlobular, and centrilobular emphysema codes, as well as an “other emphysema” code.

“Unilateral, panlobular, and centrilobular emphysema is emphysema categorized by site,” explains Sheri Poe Bernard, CPC, CRC, CCS-P, managing consultant for risk adjustment at Granite GRC Consulting.

Unilateral emphysema: This rare form of the condition is thought to have originated from infant bronchiolitis that went untreated, which caused the lung alveoli to never mature properly. Unilateral emphysema affects only the right or left lung.

You’ll report a unilateral emphysema diagnosis with J43.0 (Unilateral pulmonary emphysema [MacLeod’s syndrome]).

Panlobular emphysema: This condition affects all lobes of the lungs, but commonly resides in the lower half of the organs. Panlobular emphysema is also known as panacinar emphysema as the disease affects the acini of the lung, which contain the alveoli and are where air exchange occurs. This form of emphysema destroys the air sacs’ tissue and results in unique, uniform air space enlargement. Typically, a genetic disease, such as a homozygous alpha-1 antitrypsin deficiency, is associated with the condition.

Use J43.1 (Panlobular emphysema) to report a panlobular emphysema or panacinar emphysema diagnosis.

Centrilobular emphysema: Frequently linked to long-term cigarette smokers over 50 years old, this emphysema is the most common type of the disease. The condition starts in the respiratory bronchioles and extends throughout the upper half of the lungs primarily. Centrilobular emphysema is also known as centriacinar emphysema.

Select J43.2 (Centrilobular emphysema) to report a centrilobular emphysema diagnosis.

Paraseptal emphysema: This condition is usually related to inflammatory conditions like previous lung infections and is inclined to localize around the pleura or septa. While paraseptal emphysema is a specific type of emphysema, the ICD-10-CM code set currently does not have a code specifying the condition.

Therefore, you’ll assign J43.8 (Other emphysema) when the provider diagnoses the patient with paraseptal emphysema.

Lastly, this code category includes J43.9 (Emphysema, unspecified) to report other conditions that do not fall under the previously mentioned emphysema codes. Code J43.9 lists additional diagnoses that you can report with the code in the code set, which include:

• Bullous emphysema (lung) (pulmonary)
• Emphysema (lung) (pulmonary) not otherwise specified (NOS)
• Emphysematous bleb
• Vesicular emphysema (lung) (pulmonary)

Code J43.0 also features additional conditions that you’ll report with the code. Familiarize yourself with these terms, so you’re prepared when a pulmonologist documents one in the record.

Pay Attention to Parent Code Notes

Parent code J43.- features Excludes1 and Excludes2 notes that apply to all of the codes in the category.

“If a different form of COPD is specifically documented in addition to emphysema, it is appropriate to code both conditions. In emphysema, some alveoli have been rendered unable to perform oxygen exchange due to inflammation and scarring. In other forms of COPD, it is the bronchial tubes that are inflamed and scarred,” Bernard says.

Reminder: According to the ICD-10-CM Official Guidelines, section I.A.12.a, an Excludes1 note “is a pure excludes note.” This means that the code listed under the note should never be assigned along with the code listed above the Excludes1 note. Essentially, the two conditions cannot occur together.

The Excludes1 note for J43.- instructs you to not report the following codes with a J43.- code:

• J68.4 (Chronic respiratory conditions due to chemicals, gases, fumes and vapors)
• J98.2 (Interstitial emphysema)
• J98.3 (Compensatory emphysema)
• P25.0 (Interstitial emphysema originating in the perinatal period)
• T81.82- (Emphysema (subcutaneous) resulting from a procedure)

On the other hand, the Excludes2 note instructs you to assign an appropriate if the physician documents that the condition and the emphysema are occurring at the same time. The Excludes2 codes include:

• J44.- (Other chronic obstructive pulmonary disease)
• T79.7- (Traumatic subcutaneous emphysema)

The Excludes2 note lists two other conditions that fall under the J44.- parent code. These conditions are “emphysema with chronic (obstructive) bronchitis” and “emphysematous (obstructive) bronchitis.”

Mike Shaughnessy, BA, CPC, Development Editor, AAPC