Pulmonology Coding Alert

Question: I have a report where the pulmonologist diagnosed the patient with pneumococcal pneumonia in both lungs due to decompensated COPD. The physician also listed chronic bronchiectasis as a secondary diagnosis.

How should I report the diagnoses?

South Dakota Subscriber

Answer: You’ll assign J44.0 (Chronic obstructive pulmonary disease with (acute) lower respiratory infection) and J44.1 (Chronic obstructive pulmonary disease with (acute) exacerbation) to report the chronic obstructive pulmonary disease (COPD) with pneumonia. Code J44.0 features a Code also note instructing you to assign an appropriate code to identify the infection, which is J13 (Pneumonia due to Streptococcus pneumoniae).

Next, you’ll assign J47.9 (Bronchiectasis, uncomplicated) to report the bronchiectasis infection. Parent code J44.- (Other chronic obstructive pulmonary disease) lists bronchiectasis under the Excludes2 note, which means you may report both COPD and bronchiectasis codes when the patient is experiencing both conditions at the same time.

However, if the provider doesn’t document a specific COPD condition, then you cannot report both conditions together. According to AHA ICD-10 Coding Clinic, Volume 11, Issue 2, “[W]hen the COPD is not further specified (code J44.9, Chronic obstructive pulmonary disease, unspecified) in a patient with bronchiectasis, only the bronchiectasis is reported.”