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Decoding I-10 Dilemmas: COPD with Acute Exacerbation of Asthmatic Bronchitis

Published on 

Tuesday, July 5, 2016

 | Coding 
 | FAQ 

Dilemma:
 How do you code COPD with Acute Exacerbation of Asthmatic Bronchitis?

Solution:

Two codes are necessary to capture the full diagnosis, one code for the Acute Exacerbation of COPD (J44.1) plus a second code to identify the type of Asthma (J45.901).
Per ICD-10-CM, coders are instructed as follows:

Bronchitis (diffuse) (fibrinous) (hypostatic) (infective) (membranous) (J40)

Asthmatic (J45.9)

Chronic (J44.9)

with

Acute lower respiratory infection (J44.0)

Exacerbation (acute) (J44.1)

OR

Asthma, asthmatic (bronchial) (catarrh) (spasmodic) (J45.909)

with

Chronic Obstructive Bronchitis (J44.9)

with

Acute Lower Respiratory Infection (J44.0)

Exacerbation (acute) (J44.1)

Chronic Obstructive Pulmonary Disease (J44.9)

with

Acute Lower Respiratory Infection (J44.0)

Exacerbation (acute) (J44.1)

Under category (J44) (Other Chronic Obstructive Pulmonary Disease) there is a Code also note instructing coders to code the type of Asthma, if applicable (J45.-). In this case, Unspecified Asthma with Acute Exacerbation (J45.901) is added.

Two things to remember:

  1. Since an Acute Exacerbation is a worsening of a Chronic Condition, we automatically know that the Asthmatic Bronchitis is a Chronic condition.
  2. The diagnosis of Acute Asthmatic Bronchitis is not the same as Acute Bronchitis.

If an MD documents Acute Bronchitis and then further specifies it as Acute Asthmatic Bronchitis, a code for Acute Bronchitis (J44.0) is not coded in addition. In this case, the patient does not have Acute Bronchitis, only Acute Asthmatic Bronchitis.

If the documentation is unclear as to whether a patient has Acute Bronchitis and an Acute Exacerbation of Asthmatic Bronchitis or just an Acute Exacerbation of Asthmatic Bronchitis, query the physician for clarification. Work with your physicians to help them understand the different descriptions and options in ICD-10-CM.

Information Source(s):

  • ICD-10-CM Official Coding Guidelines
  • ICD-10-CM and ICD-10-PCS Coding Handbook, Chapter 19 – Diseases of the Respiratory System, written by Nelly Leon-Chisen, RHIA, American Hospital Association
  • TruCode encoder 
  • ICD-10-CM Expert for Hospitals, by Optum
Article Author: Susie James, RHIT, CCS
Susie James, RHIT, CCS, is the Manager of Inpatient Coding Services at MMP, Inc. Susie has worked in the coding field for over 30 years and has worked as a coder, coding supervisor, and corporate coding manager for a large multi-facility system in Birmingham. She also worked for Alabama Quality Assurance Foundation (AQAF) as a coding reviewer/auditor before joining the team at Medical Management Plus, Inc. Susie has previously served as the President of the Alabama Association of Health Information Management (AAHIM) on the Board of Directors and currently serves as the Education/Coding Roundtable Chair. She is also a member of the American Health Information Management Association (AHIMA) and has previously served as the Co-chair for AHIMA's Leadership Team. She also served as a facilitator at AHIMA's 85th National Convention in Atlanta Georgia.

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.