Cracking the Code

Coding Chronic Obstructive Pulmonary Disease (COPD)

According to the Mayo Clinic, Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production, and wheezing. It’s typically caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. Patients with COPD are at increased risk of developing heart disease, lung cancer, and a variety of other conditions.

Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. These two conditions usually occur together and can vary in severity among patients with COPD.

Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It’s characterized by daily cough and mucus (sputum) production.

The ICD-10-CM Coding Guidelines for coding acute exacerbation of chronic obstructive bronchitis and asthma, state the codes in categories J44 and J45 distinguish between uncomplicated cases and those in acute exacerbation. An acute exacerbation is a worsening or decompensation of a chronic condition. An acute exacerbation is not equivalent to an infection superimposed on a chronic condition, though an exacerbation may be triggered by an infection.

Q: A 26-year-old patient with COPD visits a physician with acute bronchitis. What ICD-10-CM code(s) should be reported?
A: J44.0, J20.9. Rationale: In our ICD-10-CM Alphabetic Index we look at Disease/pulmonary/chronic obstructive/with/acute bronchitis, J44.0. In the Tabular List, there is a note under J44.0 to use an additional code to identify the infection. Referring again to our Alphabetic Index we look for Bronchitis/acute or subacute (with bronchospasm or obstruction) J20.9. As always, we want to verify the code selection in the Tabular List.
Reference: FY 2023 ICD-10-CM codebook & guidelines, Mayo Clinic
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