Pulmonology Coding Alert

Question: If the medical record indicates that a patient has chronic obstructive bronchitis with emphysema, what is the best diagnosis code for this patient?

North Carolina Subscriber

Answer: Before arriving at the proper diagnosis, you need to check if the patient has exacerbation along with the bronchitis and emphysema. ICD-9 offers a pair of codes for these patients, depending on exacerbation.

If you see evidence of exacerbation, report 491.21 (Obstructive chronic bronchitis; with [acute] exacerbation) to represent the patient's condition.

If the notes indicate no exacerbation, report 491.20 (Obstructive chronic bronchitis; without exacerbation) instead.

Answers to You Be the Coder and Reader Questions were answered/reviewed by Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta; and Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.