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Coding Chronic Obstructive Pulmonary Disease in ICD-10

by | Aug 3, 2017 | Medical Coding News, Resources | 0 comments

According to a recent GlobalNewswire press release, prevalence of Chronic Obstructive Pulmonary Disease (COPD) has increased from around 3% to over 11.6% in people over age 65. As a medical billing company receiving a large number of claims related to services provided for this condition, we are well aware of the ICD-10 specificities involved in coding for COPD and asthma. ICD-10 allows for better capture of the clarification and quantification of the patient’s condition.

COPD is characterized by coughing, breathing difficulties, and strong mucous production in the lungs. The patients’ lungs lose their ability to repair damages on their own. Like high blood pressure, COPD, is a “silent killer”. A chronic cough is generally the first sign of COPD and as the disease progresses, the airways narrow and usually leads to pulmonary emphysema. Often triggered by smoking, it could become the world’s third most common cause of death in 2030, according to estimates from the World Health Organization (WHO).

Asthma is chronic lung disease that causes inflammation in and narrowing of the airways. It affects people of all ages and usually starts during childhood. It is estimated that more than 25 million people in the U.S. are living with asthma, and of these, about 7 million are children. Under ICD-10, asthma can further clarified based on severity as well as acute exacerbation.

For COPD and emphysema, ICD-10 offers two base code categories:

J43 – Emphysema, and
J44 – Chronic obstructive pulmonary disease (COPD)
All codes require a fourth digit.

J43 Emphysema

An additional code should be used to identify:

  • exposure to environmental tobacco smoke (Z77.22)
  • history of tobacco use (Z87.891)
  • occupational exposure to environmental tobacco smoke (Z57.31)
  • tobacco dependence (F17.-)
  • tobacco use (Z72.0)

J43.0 Unilateral pulmonary emphysema [MacLeod’s syndrome] Swyer-James syndrome Unilateral emphysema Unilateral hyperlucent lung Unilateral pulmonary artery functional hypoplasia Unilateral transparency of lung
J43.1 Panlobular emphysema Panacinar emphysema
J43.2 Centrilobular emphysema J43.8 Other emphysema J43.9 Emphysema, unspecifed Bullous emphysema (lung)(pulmonary) Emphysema (lung)(pulmonary) NOS Emphysematous bleb Vesicular emphysema (lung)(pulmonary)

J44 Chronic obstructive pulmonary disease. Includes:

  • asthma with chronic obstructive pulmonary disease
  • chronic asthmatic (obstructive)
  • bronchitis chronic bronchitis with airways obstruction
  • chronic bronchitis with emphysema
  • chronic emphysematous bronchitis
  • chronic obstructive asthma
  • chronic obstructive bronchitis chronic obstructive tracheobronchitis

If applicable, the type of asthma should be coded (J45.-)
An additional code should be used to identify:

  • exposure to environmental tobacco smoke (Z77.22)
  • history of tobacco use (Z87.891)
  • occupational exposure to environmental tobacco smoke (Z57.31)
  • tobacco dependence (F17.-)
  • tobacco use (Z72.0)

It is clear that ICD-10 offers improved clarity for COPD. However, the specificity would be lost if the patient’s problem list is not updated with the appropriate codes. Code J44 (chronic obstructive pulmonary disease) offers the following options:

J44.0 (Chronic obstructive pulmonary disease with acute lower respiratory infection).Use an additional code to identify the infection.
J44.1 (Chronic obstructive pulmonary disease with [acute] exacerbation)
Decompensated COPD
Decompensated COPD with (acute) exacerbation
J44.9 (Chronic obstructive pulmonary disease, unspecified)
Chronic obstructive airway disease
NOS Chronic obstructive lung disease NOS

Additional testing would usually be needed to clearly differentiate emphysema from chronic bronchitis. According to the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, both emphysema and chronic bronchitis are found to coexist in most COPD patients. Thus, the general term ‘COPD’ is considered to be more accurate. Therefore, in this case, J44.9, “COPD, unspecified,” should be used. With proper staff training, medical coding companies help physicians use the right I codes to manage ICD-10 implementation smoothly.

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