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Breathing Easier with ICD-10-CM

Published on 

Friday, August 23, 2013

 | Coding 
 | Documentation 

One thing that we all continue to hear about the transition to ICD-10-CM is the increased specificity of the codes. Asthma is one example of the increased specificity with ICD-10-CM. ICD-9-CM used an older classification for Asthma that is no longer relevant for treatment. Over the years the guidelines and classifications of Asthma have been revised. The latest update was released in 2007 by the National Asthma Education and Prevention Program which is coordinated by the National Heart, Lung and Blood Institute (NHLBI). ICD-10-CM has incorporated the classifications listed below into the new code set.

  • Mild Intermittent Asthma (J45.2_)
  • Symptoms occur less than two days per week and no interference with regular activities.
  • Fewer than 2 days a month of night time symptoms
  • Lung Function Tests (LFTs) are normal when they are not having an asthma attack
  •  Mild Persistent Asthma(J45.3_)
  • Symptoms occur more than 2 days per week, but not every day and there is interference of daily activities.
  • Three to four times a month of night time symptom occurrences
  • LFTs are normal when not having an asthma attack
  •  Moderate Persistent Asthma (J45.4_)
  • Symptoms occur daily requiring inhaled asthma medication and may restrict physical activity
  • Night time symptoms occur more than once a week, but not every day
  • Abnormal LFTs
  • Severe Persistent Asthma (J45. 5_)
  • Symptoms occur throughout the day with frequent severe attacks limiting the ability to breathe and perform physical activities
  • Night time symptoms sometimes occur every night
  • Abnormal LFTs

It is interesting to note that in ICD-9-CM Extrinsic Asthma codes to 493.0x and Intrinsic Asthma codes to 493.1x. However, in ICD-10-CM both Extrinsic/Intrinsic (allergic and nonallergic) are assigned to J45.909, Unspecified Asthma.

A discussion needs to take place with your physicians who treat Asthma patients to make them aware of the updated classifications so their documentation will reflect the medical complexity of their patients. Talking to your physicians now will hopefully reduce the amount of queries in the future.

Below are the links that contain the clinical information and updated guidelines for Asthma.

 http://www.nhlbi.nih.gov/guidelines/asthma/asthsumm.pdf

 http://www.webmd.com/asthma/tc/classification-of-asthma-topic-overview

Article Author: Anita Meyers, RHIT, CCS
Anita Meyers, RHIT, CCS, is an Inpatient Coding Professional at Medical Management Plus. Anita has over twenty-six years of experience in inpatient and outpatient coding including 17 years of work at AQAF reviewing inpatient and outpatient records from Alabama hospitals. In addition to reviewing records she was the team leader in Beneficiary Services where she participated in case review activities, received and processed beneficiary complaints and handled fee-for-service denials for home health, hospice and skilled nursing facility services. Prior to joining the MMP team, Anita left AQAF to become an inpatient contract coder and worked at various hospitals in central Alabama. In her current position, Anita is an integral part of the Inpatient Services at Medical Management Plus.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.