Pulmonology Coding Alert

The pulmonologist's documentation, along with the patient's medical record, can make or break your chronic obstructive pulmonary disease (COPD) reporting. One key is making sure that your coding accurately identifies the patient's specific pulmonary condition and any other associated acute condition (if necessary).

Background: According to the National Heart Lung and Blood Institute, COPD is a serious lung disease that, over time, makes it hard to breathe. In people who have COPD, the airways --" the bronchial tubes hrough which air moves in and out of your lungs --" are partially blocked, which makes it more difficult to get air out than in.

These hints will help you determine which ICD-9 codes you should report when the patient has other conditions that are related to COPD.

Asthma is a disease distinct from COPD. However,the two may co-exist in the same patient. The ICD-9 493 category includes all the asthma codes you might need. If your pulmonologist diagnoses COPD and asthma together, look to the terms he uses in the medical record and use them as your guide to select which code to report.

The asthma codes you'll choose from are:

• 493.20 --" Chronic obstructive asthma, unspecified

• 493.21 --" Chronic obstructive asthma with status asthmaticus

• 493.22 --" Chronic obstructive asthma with acute exacerbation.

Heads up: You might find some confusion about selecting 493.20, a less-specific code. You should clarify with the pulmonologist if the patient has status asthmaticu s or an acute exacerbation before opting to go for the "default" code. If the patient does not have either of these two conditions, only then should you use 493.20. Underdocumented details may affect the most specific ICD-9 code selection.

Additionally, if your pulmonologist documents status asthmaticus with any type of COPD, you should list that diagnosis first. The status asthmaticus diagnosis "supercedes any type of COPD, including that with acute bronchitis or acute exacerbation," says Deborah J. Grider, CMA, CPC, CPC-H, CPC-P, CCS-P, CCP, EMS, president of Indianapolis-based Medical Professionals Inc and author of the American Medical Association's Principles of ICD-9-CM Coding. You should only assign the fifth digit of "1" in this case (493.21), not the fifth digit of "2" (493.22).