Radiology Coding Alert

Question: On a chest X-ray, the indication notes an intermittent smoker, but used to be a heavy user. The doctor documents chronic obstructive pulmonary disease (COPD) and notes that it is probably due to the patient’s history of smoking. Should I report a tobacco use code since the patient doesn’t smoke as often anymore?

Minnesota Subscriber

Answer: Part of this answer is covered in Volume 30, Number 4 of the 2013 AHA Coding Clinic. As long as the physician documents that the patient is a “smoker,” you should code the patient as such. Using the index, “Smoker” will lead you to “see Dependence, drug, nicotine.”

Since the physician states that the COPD is “probably” due to the patient’s extensive smoking history, you should not consider this a definitive diagnosis. Therefore, code F17.218 (Nicotine dependence, cigarettes, with other nicotine-induced disorders) is inappropriate in this instance. You will report the patient with the primary diagnosis of J44.9 (Chronic obstructive pulmonary disease, unspecified) unless there is a separate primary reason for the patient’s exam. As a secondary diagnosis, you will report F17.210 (Nicotine dependence, cigarettes, uncomplicated).