Pulmonology Coding Alert

Question: My physician noted that a patient has "acute exacerbation of emphysema." The pulmonologist also said that the patient does not have chronic bronchitis. I don't see a diagnosis code for this. What should I use?


Alaska Subscriber
Answer: You should report ICD-9 code 491.21 (Obstructive chronic bronchitis, with [acute] exacerbation). Even though the patient may not have chronic bronchitis, 491.21 would be the most appropriate diagnosis code to use since it represents a variety of conditions.

If you look beyond the initial code descriptor for 491.21, you'll see that this ICD-9 code also includes:

• acute exacerbation of chronic obstructive pulmonary disease (COPD)
• decompensated chronic obstructive pulmonary disease (COPD)
• decompensated chronic obstructive pulmonary disease (COPD) with exacerbation As demonstrated with these additional code descriptors, the patient condition is not limited to chronic bronchitis for you to be able to report 491.21.