Coding for COPD – An Overview

Coding for COPD –An Overview COPD is a chronic lung condition that obstructs the airways, causing breathing difficulty. This article discusses in detail about coding COPD condition.

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Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs, causing difficulty in breathing. Emphysema and chronic bronchitis are the two most common types of COPD and in most cases people develop both these conditions. Common symptoms include breathing difficulty, cough, mucus (sputum) production, chest tightness and wheezing. Even though there is no cure for this life-threatening disease, regular and timely screening and diagnosis can help in early detection of COPD symptoms and better disease management, before any major loss of lung function occurs. Medical coding for COPD is a complex process, as several other associated conditions fall under this disease category. Hiring the services of a reputable medical coding company enables pulmonary specialists to ensure correct coding of COPD and save valuable time that can be invested in patient care.

Smoking is the primary cause/risk factor for COPD. However, long term exposure to chemical irritants – such as lung pollution, chemical fumes or dust may also contribute to this chronic lung disorder. To diagnose this condition, physicians / pulmonary specialists will review your signs and symptoms, discuss your family and medical history and discuss any kind of exposure that you have had to lung irritants – especially cigarette smoking.

Several diagnostic tests such as lung (pulmonary) function tests, chest X-rays, CT scan and arterial blood gas analysis will be conducted to accurately diagnose this condition.

How to Code for COPD? While coding diagnoses of chronic obstructive pulmonary disease and its associated conditions such as emphysema, chronic bronchitis, acute bronchitis, chronic asthmatic bronchitis and acute asthmatic bronchitis, it is important to understand the coding consequences because the presence of two or more of these conditions may make these tasks complicated and create errors. Therefore, it is crucial to check whether the condition is acute, chronic or in acute exacerbation.

The ICD-10 guidelines specify – “If the same condition is described as both acute (subacute) and chronic and separate sub-entries do exist in the alphabetic index at the same indention level, code both and sequence the acute (sub-acute) code first.”

If a definitive diagnosis of COPD is not made, it is recommended to code only the symptoms.

In coding, if patients have COPD and asthma documented, without any further specificity of the type of asthma, only COPD would be reported.

COPD When COPD is confirmed, code - J44 would be reported. 

J44 - Other chronic obstructive pulmonary disease

  

J44.0 - Chronic obstructive pulmonary disease (COPD), with acute lower respiratory infection and pneumonia J44.1 - Chronic obstructive pulmonary disease with (acute) exacerbation J44.9 - Chronic obstructive pulmonary disease, unspecified

Asthma If any type of asthma is applicable, use J45 as well as a Z code to identify any documented factors influencing the patient’s health status.       

J45 - Asthma J45.2 - Mild intermittent asthma J45.3 - Mild persistent asthma J45.4 - Moderate persistent asthma J45.5 - Severe persistent asthma J45.9 - Other and unspecified asthma J45.99 - Other asthma

Occupational/Environmental Factors Cigarette smoking is regarded as one of the leading causes of COPD. However, one out of six people diagnosed with this lung disorder has never smoked. As discussed above, long term exposure to environmental or occupational chemical irritants or genetics can be other risk factors.   

Z57.2 - Occupational exposure to dust Z57.31 - Occupational exposure to environmental tobacco smoke Z77.22 - Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic)

COPD and Emphysema COPD and Emphysema covers smoking history, chest CT results to identify the type of emphysema (whether - centrilobular, septal).    

J43 - Emphysema J43.1 - Panlobular emphysema J43.2 - Centrilobular emphysema J43.8 - Other emphysema

COPD with Acute Bronchitis    

J20- Acute bronchitis J40 - Bronchitis, not specified as acute or chronic J41- Simple and mucopurulent chronic bronchitis J41.0 - Simple chronic bronchitis

Accurate medical coding on medical claims is important to ensure correct and on-time documentation and reimbursement. Outsourcing pulmonary medical billing and coding services can relieve pulmonary specialists from the hassles of medical coding, and enable them to focus on providing dedicated patient care.