By: Brionna Benedetti CPC, CRC
November is a time of festivities, falling leaves, and crisp cool mornings that usher in the changing of the seasons. November is also the host of National COPD Awareness Month, where we take a moment to recognize a very real and pervasive health issue that is the third leading cause of death worldwide (UNICEF). Chronic obstructive pulmonary disease (COPD) is an umbrella term describing lung diseases that restrict airflow. Emphysema and chronic bronchitis are part of the COPD disease category, with symptoms ranging from difficulty breathing to chronic cough and fatigue. With worsening symptoms, patients who suffer from this condition are also at higher risk of lung infections, lung cancer, cardiovascular complications, depression, and anxiety (UNICEF).
Smoking in all forms is a key factor in the development of COPD, but COPD also has socioeconomic implications that disproportionately affect impoverished and marginalized populations. According to a study performed in 2019 by the Journal of Thoracic Disease, there is a positive correlation between individuals living below the poverty line and an increased prevalence of COPD (Lee YS). With air pollution, occupational exposures, and asthma also being key causes of COPD later in life, it is important that we use ICD-10-CM coding to reflect just how seriously this disease affects our patients.
The coding of COPD can be a tricky matter that depends on how the patient presents at the time of the visit. There are three main COPD codes:
J44.0 Chronic obstructive pulmonary disease with ACUTE lower respiratory infection (code also the respiratory infection).
J44.1 Chronic obstructive pulmonary disease with ACUTE exacerbation (excludes bronchitis).
J44.9 Chronic obstructive pulmonary disease, unspecified.
These codes distinguish between uncomplicated (stable) COPD and those cases with acute exacerbations. Acute exacerbation is defined by the ICD-10-CM as the worsening or decompensation of a chronic condition (acute or chronic). Specificity in documentation is key to correct code assignment, requiring that the provider give a full description of the patient’s acuity and the correlating factors that contributed to the disease state. When documenting for COPD, a provider should define:
- If the condition is stable or having an acute exacerbation,
- What has caused the exacerbation (i.e., respiratory infections),
- If the patient is an active smoker (F17.-) or a past smoker (Z87.891),
- If the patient has COPD and asthma, code also asthma (J45.-),
- Secondhand/environmental smoke exposure (Z77.22) or occupational smoke exposure (Z57.31),
- Family history of respiratory disease (Z83.6),
- And if the patient is dependent on supplemental oxygen (Z99.81).
Vaping-related disorders are not included in the F17.- smoking codes, as those codes are specific to tobacco-related products. To code for vaping-related disorders, see code U07.0. For patients presenting to the clinic for a lung injury due to vaping, code U07.0 is the principal diagnosis, and assign additional codes for the other manifestations, such as respiratory failure (J96.-). Do not code for the symptoms like couch shortness of breath, etc. when the formal diagnosis of U07.0 is used (ICD-10-CM).
Emphysema is a more severe form of COPD, in that the structure of the air sacs in the lungs are permanently damaged and weakened. As a result of this extra level of complexity, emphysema has its own code category (J43.-) that can be further defined by the type of emphysema present. Code for emphysema when only emphysema is documented, and do not add the code for COPD (J44.-). When emphysema and chronic obstructive bronchitis present together, code for the appropriate COPD (J44.-) code (ICD-10-CM). Emphysema also requires additional code selections to show smoking history, and environmental and occupational factors to further explain the disease state.
There are many considerations when looking at the holistic history of a patient’s lung health, with self-exposure, and economic and environmental factors taking their individual tolls on the body. It can be a daunting task to describe the onset of the symptoms appropriately and to get a full history of how a patient developed COPD, but it is imperative to see the whole picture to ensure the health literacy and behavior modification of the patient. By understanding where the patient truly is and how they understand things, we can better help them make lifestyle and environmental modifications and reduce the likelihood of extreme disease progression.
Sources:
- ICD-10-CM: The Complete Official Codebook. (2023). American Medical Association.
- Lee YS, Oh JY, Min KH, Lee SY, Kang KH, Shim JJ. The association between living below the relative poverty line and the prevalence of chronic obstructive pulmonary disease. J Thorac Dis. 2019 Feb;11(2):427-437. doi: 10.21037/jtd.2019.01.40. PMID: 30962986; PMCID: PMC6409249.
- UNICEF. (2023, March 16). Chronic obstructive pulmonary disease (COPD). World Health Organization. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
