Pulmonology Coding Alert

Question: A patient who we diagnosed with COPD last year presented to our office last week with difficulty breathing. Following a series of tests and an examination, the pulmonologist diagnosed the COPD patient with an acute exacerbation of her moderate persistent asthma. Which ICD-10 code applies to this situation?

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Answer: To report this condition, you may be tempted to submit J44.1 (Chronic obstructive pulmonary disease with [acute] exacerbation), but you’re not all the way there. Instead, you’ll need to report two codes for this patient. First, list J45.41 (Moderate persistent asthma with (acute) exacerbation) and then follow with J44.1.

Here’s why: The ICD-10-CM code book lists a note under the heading to J44 (Other chronic obstructive pulmonary disease) that says, “Code also type of asthma, if applicable.” Since you know the type of asthma, J45.41 is essential to report in addition to J44.1. As with the first example above, you are not required to bill either code as the primary when ICD-10 includes a “code also” note, leaving the pulmonologist to determine which should be the primary diagnosis. In most cases, since the patient is presenting to address the asthma, that code will typically be listed first.