Pulmonology Coding Alert

Question: A patient with COPD presented to an urgent care clinic complaining of cough, sore throat, shortness of breath. Following a patient history, physical evaluation, and review of throat culture results, the physician diagnosed the patient with COPD with acute bronchitis due to echovirus.

We originally reported J44.0 for the patient’s diagnosis, but the claim was denied. How do we correct the claim?

New Jersey Subscriber

Answer: Your original claim was partially correct by including J44.0 (Chronic obstructive pulmonary disease with (acute) lower respiratory infection) to report the patient’s chronic obstructive pulmonary disease (COPD) and an acute bronchitis infection. However, the claim is missing another ICD-10-CM code for the physician’s final diagnosis.

When you examine J44.0 in the ICD-10-CM code set Tabular List, you’ll notice a Code also note listed under the code. The Code also note instructs you to use another diagnosis code to identify the infection, which is acute bronchitis due to echovirus.

In the Alphabetic Index, look for Bronchitis > acute or subacute > due to > virus > echovirus, which directs you to J20.7 (Acute bronchitis due to echovirus). You’ll then verify the code in the Tabular List.