COPD

This month’s “In the kNOW” article will address the coding of COPD.  Chronic obstructive pulmonary disease is a condition that affects the lungs.  It may be chronic bronchitis or emphysema.  Chronic bronchitis causes the airways to narrow due to inflammation, while emphysema impacts the alveolar sacs in the lungs by trapping air and compromising the ability to exhale completely.  This causes the reduction of oxygen available to circulate throughout the body.

In ICD-10-CM coding of COPD is based on the complete diagnostic statement.  If the only condition documented is COPD, the proper code assignment is J44.9.  If the physician documents COPD and emphysema, then the coding professional should assign J43.9.  The rationale for this is explained in a 4^th Qtr. 2017 Coding Clinic, which states that emphysema is a specific type of COPD.  Therefore, when both conditions are documented, code the more specific diagnosis only, J43.9. 

If COPD is documented along with a lower respiratory infection, such as pneumonia or bronchitis, then the COPD is coded as J44.0.  Remember, this applies only to COPD with a lower respiratory infection.  So, if the patient has influenza, we would not assign J44.0 since influenza is considered an upper and lower respiratory infection.  Additionally, do not assign J44.0 if COPD is documented with aspiration pneumonia.  That type of pneumonia is considered a lung disease due to an external cause rather than a lower respiratory infection. 

There are instances when COPD suddenly becomes worse for a period of time.  This is called an acute exacerbation.  When COPD is in acute exacerbation, the appropriate code is J44.1.  There may be instances when a patient is suffering from both an acute exacerbation of COPD and a lower respiratory infection.  In those circumstances, assign both J44.0 and J44.1 along with the code specifying the lower respiratory infection (ie. acute bronchitis).

When asthma is present in a patient with COPD, assign only code J44.9.  This is true unless the patient’s asthma is specified by type such as mild persistent asthma, in which case assign both the COPD code (J44.9) and the specific asthma code (J45.30).   If the patient’s asthma is stated as being in acute exacerbation, coding professionals may assign both J44.9 and J45.901.  The 4^th Qtr. 2017 Coding Clinic indicated the appropriateness of this code assignment by stating that the diagnosis of acute exacerbation of asthma not further qualified is, in itself, a specific type of asthma.  Therefore, the code assignment of J45.901 along with J44.9 is acceptable. 

Now you are In the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.