Pulmonology Coding Alert

Question: Our pulmonologist recently diagnosed a patient to be suffering from Emphysema/ COPD, chronic bronchitis and asthma. How would the diagnosis be reported?

Nevada Subscriber

Answer: When your pulmonologist diagnoses a patient with conditions that comprise of chronic obstructive pulmonary disease (COPD) and chronic bronchitis, you will need to report the diagnosis with 491.2 (Obstructive chronic bronchitis). Since the patient also suffered from emphysema with chronic obstructive bronchitis, you will have to report the diagnosis using the fifth digit expansion for 491.2, namely, 491.20 (Obstructive chronic bronchitis without exacerbation) as the descriptors for 491.20 includes emphysema with chronic bronchitis. If emphysema is diagnosed without chronic bronchitis, you will need to report it with 492 (Emphysema). Based on the type of emphysema, you will need to use a 4^th digit expansion and report emphysema using the following codes:

• 492.0 (Emphysematous bleb) – This code will include diagnosis of giant bullous emphysema, ruptured emphysematous bleb, tension pneumatocele and vanishing lung
• 492.8 (Other emphysema) – This code will include diagnosis of centilobular, panlobular, unilateral (MacLeod’s syndrome) and vesicular type of emphysema

You will need to report asthma using 493 (Asthma). When present with obstruction, you can report it with 493.2x (Chronic obstructive asthma). You cannot use 496 (Chronic airway obstruction, not elsewhere classified) to report a diagnosis of COPD unless your pulmonologist does not specify in the documentation as to what type of obstructive pulmonary condition he is treating.

For more details on diagnosis of COPD and asthma, check out http://www.cdc.gov/nchs/data/icd9/icd9cm_guidelines_2011.pdf.