Pulmonology Coding Alert

Question:

Hawaii Subscriber

Bronchitis is a common condition that patients with COPD have. In this case, you should report 491.22 (Obstructive chronic bronchitis, with acute bronchitis). You don't have to additionally report 466.0 (Acute bronchitis) for the obstructive chronic bronchitis since the code descriptor for 491.22 specifies acute bronchitis.

Tip: If your physician documents that a patient has acute bronchitis with COPD which is causing an acute exacerbation, for your coding purposes, the bronchitis supercedes the exacerbation. Therefore, you should still report 491.22. If, however, the documentation states that the patient has COPD with acute exacerbation, but doesn't mention acute bronchitis, report 491.21 (Obstructive chronic bronchitis, with[ acute] exacerbation).

Exception: If your pulmonologist diagnoses COPD and there are no other manifestations or conditions, such as chronic bronchitis or emphysema, that are associated with COPD, you should use code 496 (Chronic airway obstruction, not elsewhere classified).

More importantly, make sure the documentation supports the physician's diagnosis if you're going to list a COPD diagnosis code. For instance, the documentation should include a listing of signs, symptoms and conditions.

Your pulmonologist should also document the tests he orders, such as x-rays (71010-71035), and pulmonology function tests (PFT, such as 94010-94060), and also any therapeutic drug treatment associated with the plan of care for the patient. The tests and treatments help support your physician's diagnosis of COPD.