Pulmonology Coding Alert
Know What Separates J44.1 From J44.0
Question: A patient with mild intermittent asthma and chronic obstructive bronchitis presented to our pulmonology clinic with complaints of fever, headache, cough, and a sore throat. The pulmonologist performed a physical exam and testing. After reviewing the results, the provider diagnosed the patient with pneumonia. I’m new to pulmonology coding. Could you please help me choose the correct diagnosis codes? Virginia Subscriber Answer: Your report will include three ICD-10-CM codes to cover the documented diagnoses. First, you’ll assign J44.0 (Chronic obstructive pulmonary disease with (acute) lower respiratory infection) to report the chronic obstructive bronchitis with pneumonia diagnosis. Parent code J44.- (Other chronic obstructive pulmonary disease) features an Includes note instructing you to use the appropriate J44.- code to report chronic obstructive bronchitis. Why not J44.1? You may be tempted to assign J44.1 (Chronic obstructive pulmonary disease with (acute) exacerbation) in this situation, but that would be incorrect. The acute exacerbation in the code descriptor relates to the patient’s chronic obstructive pulmonary disease (COPD) or chronic obstructive bronchitis, where the patient is experiencing an aggravation of their chronic condition. Next, you’ll review the coding instructions listed under J44.0. The code carries a Code also note that instructs you “to identify the infection.” Based on what you’ve provided in your question, you’ll assign J18.9 (Pneumonia, unspecified organism) to report the pneumonia infection. Double-check the documentation: The ICD-10-CM code set includes several pneumonia code categories that pertain to different infections. For example, the J12.- (Viral pneumonia, not elsewhere classified) codes describe pneumonia diagnoses that are a result of viral infections. You’ll want to choose the most specific pneumonia code if the provider’s documentation specifies the type of pneumonia. Lastly, you’ll assign J45.20 (Mild intermittent asthma, uncomplicated) to show the patient suffers from mild intermittent asthma, which can affect the physician’s medical decision making (MDM). In summary, you’ll assign J44.0, J18.9, and J45.20 to report this encounter.
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