Pulmonology Coding Alert

Question: I just started a new job as a pulmonology coder, and I have very minimal experience coding respiratory conditions. I have a report that lists a patient’s diagnosis as exercise-induced asthma. The provider’s report doesn’t indicate the severity of the asthma, so I’m not sure if the patient’s condition is mild, moderate, or severe.

How would I code the diagnosis?

Illinois Subscriber

Answer: You’ll assign J45.990 (Exercise induced bronchospasm) to report the diagnosis. Exercise-induced bronchospasm (EIB) is a form of asthma that’s exacerbated by physical exertion.

In the ICD-10-CM Alphabetic Index, you’ll search for Bronchospasm > exercise induced, which provides you with J45.990. You’ll then turn to the tabular list to verify the code.

Coding EIB doesn’t require you to know the severity of the patient’s symptoms. However, coding other forms of asthma does require the severity and how often the patient experiences the condition, if specified. These conditions include:

• J45.2- (Mild intermittent asthma)
• J45.3- (Mild persistent asthma)
• J45.4- (Moderate persistent asthma)
• J45.5- (Severe persistent asthma)

Each of these code subcategories requires 5th characters to complete the code. The 5th character allows you to report if the patient’s asthma is uncomplicated, with (acute) exacerbation, or if the patient is status asthmaticus. Status asthmaticus is an exacerbation of asthma where the condition is unresponsive to treatment. This condition requires immediate medical attention as it is life threatening. When a patient is status asthmaticus, they may be unable to speak in full sentences, be confused, agitated, or unable to concentrate. The patient may also have a bluish tint to their lips if they are status asthmaticus.