2018
Documenting and Coding Asthma in ICD-10
ICD-10 codes for asthma are based on the severity of the condition, such as mild intermittent, mild persistent, moderate persistent.
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Asthma is a chronic lung disease that inflames and narrows the airways in the lungs and can make breathing difficult and trigger coughing, wheezing and shortness of breath. Allergic asthma can be life-threatening. According to the American Academy of Allergy Asthma and Immunology, one in 12 people (about 25 million, or 8% of the U.S. population) had asthma in 2009, compared with 1 in 14 (about 20 million, or 7%) in 2001. An allergist / immunologist diagnosing and treating asthma should document it for further reference and for reimbursement purposes. They can also rely on medical coding outsourcing to meet the complex coding tasks The ICD-10 code set combines both intrinsic and extrinsic into one category, making it easier for coders to look for documentation. In ICD-10, asthma is coded in as intermittent or persistent, adding mild - moderate - severe as descriptors, just as physicians would describe patients. The following conditions should be included while documenting asthma: • •
Cause: Exercise-induced, cough variant, related to smoking, chemical or particular cause, occupational Severity: For persistent asthma patients, one of the following options should be used: - Mild persistent - Moderate persistent - Severe persistent
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Temporal Factors: Acute, chronic, intermittent, persistent, status asthmaticus, acute exacerbation
Category Differentiated by temporal factors, mild asthma has two appropriate categories, such as • •
J45.2 Mild intermittent asthma J45.3 Mild persistent asthma
Moderate and severe asthma • •
J45.4 Moderate persistent asthma J45.5 Severe persistent asthma
If the condition cannot be identified as mild, moderate or severe, it can be coded as • •
J45.99 Other asthma Or J45.90 Unspecified asthma
The ‘other asthma’ category has three unique options: exercise induced bronchospasm, cough variant asthma, and other asthma. www.outsourcestrategies.com
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Three further sub-categories are - uncomplicated, with acute exacerbation and status asthmaticus.
Uncomplicated • • •
J45.20 Mild intermittent asthma, uncomplicated J45.50 Severe persistent asthma, uncomplicated J45.909 Unspecified asthma, uncomplicated
Acute exacerbation • • • • •
J45.21 Mild intermittent asthma with (acute) exacerbation J45.31 Mild persistent asthma with (acute) exacerbation J45.41 Moderate persistent asthma with (acute) exacerbation J45.51 Severe persistent asthma with (acute) exacerbation J45.901 Unspecified asthma with (acute) exacerbation
Status asthmaticus • • • • •
J45.22 Mild intermittent asthma with status asthmaticus J45.32 Mild persistent asthma with status asthmaticus J45.42 Moderate persistent asthma with status asthmaticus J45.52 Severe persistent asthma with status asthmaticus J45.902 Unspecified asthma with status asthmaticus
Causes While the main cause of asthma is smoking, other risk factors include having allergic conditions, family history of allergies or asthma, being overweight, and exposure to second hand smoke and occupational triggers. Documenting the cause of the condition requires using other common codes such as • • • • • • •
Z77.22 Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic) P96.81 Exposure to (parental) (environmental) tobacco smoke in the perinatal period Z87.891 Personal history of nicotine dependence Z57.31 Occupational exposure to environmental tobacco smoke F17.228 Nicotine dependence, chewing tobacco, with other nicotine-induced disorders F17.298 Nicotine dependence, other tobacco product, with other nicotine-induced disorders Z72.0 Tobacco use
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Coders at hospitals and medical coding companies must also be aware of other exceptions from a diagnosis as J45 asthma, such as • • • • •
J67.8 Hypersensitivity pneumonitis due to other organic dusts (wood asthma) J69.8 Pneumonitis due to inhalation of other solids and liquids (detergent asthma) J82 Pulmonary eosinophilia, not elsewhere classified (eosinophilic asthma) J60 Coal worker's pneumoconiosis (miner's asthma) R06.2 Wheezing
These types of asthma cannot be combined with a J45 code because the conditions cannot coexist. However, chronic obstructive asthma (J44.9) can be included in the submitted code because the condition can coexist with a J45 code. A clear understanding of the structure and organization of ICD-10 is critical to code this condition that comes with a wide variety of potential choices. Several studies also exist that links between asthma in women and changes in levels of female hormones such as estrogen and progesterone. Let us discuss this topic in our next blog.
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