You Be the Coder:
Differentiate Between 491.20 and 491.21
Published on Tue Oct 04, 2005
Question: The pulmonologists I work with have several patients with exacerbation of COPD. I have been instructed by the person who was here before me to use 491.21 for that condition. Is that correct? Reading the information under that code led me to believe that 491.21 is bronchitis- and emphysema-driven, so my question is, would this be the most appropriate code for COPD with exacerbation?
South Carolina Subscriber
Answer: You should use 491.21 (Obstructive chronic bronchitis with [acute] exacerbation) to report exacerbations in patients diagnosed with obstructive bronchitis and emphysema. In addition, you can use the code for acute exacerbation of chronic obstructive pulmonary disease (COPD) or decompensated COPD, with or without exacerbation.
You should use 491.20 (Obstructive chronic bronchitis without exacerbation) for obstructive bronchitis and emphysema without an exacerbation. The ICD-9-CM book includes descriptors in the Tabular List to assist in identifying all the conditions that are associated with a particular code. A good idea is to refer to this when making your final code selection. Always use an updated version of all coding tools.
