COPD Coding Precautions

by | Last updated May 19, 2023 | Published on Mar 14, 2014 | Medical Coding

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Assigning the ICD-9-CM Diagnosis Code 496 is not as simple as it looks. ICD-09-CM code 496 indicates chronic obstructive pulmonary disease or COPD which is defined as chronic airway obstruction, not elsewhere classified and applies to the following chronic conditions

  • nonspecific lung disease
  • obstructive lung disease
  • obstructive pulmonary disease (COPD) NOS

The following terminology also describes COPD

  • Acute exacerbation of chronic obstructive airways disease
  • Chronic obstructive lung disease
  • Chronic obstructive pulmonary disease with acute lower respiratory infection
  • End stage chronic obstructive airways disease
  • Mild chronic obstructive pulmonary disease
  • Moderate chronic obstructive pulmonary disease
  • Severe chronic obstructive pulmonary disease

COPD is a nonspecific term to describe symptoms that may occur as part of another, more specific condition. The point to note is that the use of ICD Code 496 is suitable only when a more precise disease process has not been identified. In fact, there are 24 specific ICD-9-CM code listings with which COPD should not be listed separately.

ICD-9 Code 496 should not be used to code for symptoms such as chronic bronchitis, asthma or emphysema. There are separate ICD-9 codes for these conditions and others. COPD is included within categories 491-493:

  • chronic obstructive lung disease [COPD] specified (as) (with):
    • allergic alveolitis (495.0-495.9)
    • asthma (493.2)
    • bronchiectasis (494.0-494.1)
    • bronchitis (491.20-491.22) with emphysema (491.20-491.22)
    • decompensated (491.21)
  • emphysema (492.0-492.8)

The key to accurate COPD coding therefore lies in the proper assessment of physician documentation. For instance, if the physician documents COPD and emphysema, the appropriate code is 492.0 which includes COPD. If COPD and asthma are listed, 493.2x (Chronic obstructive asthma) should be reported.

Coding and documentation are the major challenges that physicians face when it comes to ensuring proper compensation. A professional medical coding company can help. Expert medical coders keep track of annual coding changes and payer guidelines to assure appropriate reimbursement for client practices.

Rajeev Rajagopal

Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.

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