Pulmonology Coding Alert

Question: Thanks for your guide to COPD diagnoses last month — we were particularly interested in the part about coding for COPD with bronchitis, because we see related conditions a lot. Are there other combination codes for reporting COPD with associated conditions?

Virginia Subscriber

Answer: You’ll find that many COPD patients have associated conditions. Check out the following to determine how to select the right codes for these situations.

COPD-related asthma: If your provider documents both COPD and COPD with acute asthma exacerbation, for example, then you should code J44.9 for the COPD along with J45.901 (Unspecified asthma with (acute) exacerbation) for the acute exacerbation of the asthma.

COPD with pneumonia: If both COPD and pneumonia are present, assign J44.9 with J18.9 (Pneumonia, unspecified organism) unless your provider documents another related cause. Depending on the reason for the visit, either diagnosis may be sequenced first.

COPD with acute bronchitis: Here, you’ll code J44.0 (Chronic obstructive pulmonary disease with (acute) lower respiratory infection) first. Then, following the “Code Also” note that accompanies the code, which states “Code also to identify the infection,” you’ll chose a code from the J20.- (Acute bronchitis) category, using J20.9 (Acute bronchitis, unspecified) if your pulmonologist does not specify the infectious agent.

COPD with emphysema: If your provider documents COPD, or COPD with exacerbation and emphysema, only the emphysema is reported, leading you to the J43 (Emphysema) codes if your provider documents these particular conditions. This is because there’s an Excludes1 note under J44 that references emphysema without chronic bronchitis (J43.-), which means the two conditions are mutually exclusive from an ICD-10 perspective.

However, if COPD, emphysema, and chronic bronchitis are all documented, then only assign J44.9 for the COPD, since a corresponding Excludes1 note under J43 refers ICD-10 users to J44 for emphysema with chronic (obstructive) bronchitis.