Pulmonology Coding Alert

Question: I really enjoyed how your article “Give Your COPD Coding Know-How a Reboot” in Pulmonology Coding Alert, Volume 23, Issue 8, gave an in-depth look at chronic obstructive pulmonary disease (COPD) coding.

Do you have any advice on reporting exposure of, dependence on, or use of tobacco for patients diagnosed with COPD?

North Carolina Subscriber

Answer: Cigarette smoke is a common cause of COPD, and the ICD-10-CM code set takes that into account. The J44.- (Other chronic obstructive pulmonary disease) code category features a section listed under the parent code that instructs you to use an additional code to identify the patient’s use of tobacco (current or past), exposure to tobacco smoke, or dependence on tobacco.

These additional codes include:

• Z77.22 (Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic))
• Z87.891 (Personal history of nicotine dependence)
• Z57.31 (Occupational exposure to environmental tobacco smoke)
• F17.- (Nicotine dependence)
• Z72.0 (Tobacco use)

Code F17.- carries a 4th character required icon, which provides you with F17.2 (Nicotine dependence). Code F17.2 features a 5th character required icon, which allows you to choose from the following types of nicotine dependence:

• F17.20- (Nicotine dependence, unspecified)
• F17.21- (… cigarettes)
• F17.22- (… chewing tobacco)
• F17.29- (… other tobacco product)

These nicotine dependence codes carry 6th character required icons to complete the codes. The 6th characters allow you to specify if the patient’s dependence is uncomplicated, in remission, if the patient is experiencing withdrawal, or if the patient is experiencing nicotine-induced disorders.