If the documentation supports that the patient has a specific type of asthma documented and COPD, both codes could be reported. An example would be documentation in the record is COPD and moderate persistent asthma. In this case, two codes would be reported.
Table 1ICD-9-CM CodeDescription492.8Other emphysema493.22Chronic obstructive asthma with acute exacerbation496Chronic airway obstruction, not elsewhere classified518.81Acute respiratory failure12 more rows
Chronic obstructive pulmonary disease, unspecified J44. 9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM J44. 9 became effective on October 1, 2021.
DiagnosisSuggestive features*AsthmaLargely reversible airflow limitationCentral airway obstruction (eg, bronchogenic or metastatic cancer, lymphadenopathy, scarring from endotracheal tube)Monophonic wheeze or stridorVariable inspiratory or fixed slowing on flow volume loopChest radiograph often normal29 more rows
The ICD-CM codes for asthma have changed from 493.00 – 493.99 in ICD-9-CM to J45.
Code J45* is the diagnosis code used for Asthma. It is a common chronic disease in which the bronchial airways in the lungs become narrowed and swollen, making it difficult to breathe.
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).
ICD-10 Code for Chronic obstructive pulmonary disease with (acute) exacerbation- J44. 1- Codify by AAPC.
9 – Chronic Obstructive Pulmonary Disease, Unspecified. ICD-Code J44. 9 is a billable ICD-10 code used for healthcare diagnosis reimbursement of Chronic obstructive pulmonary disease. This is sometimes referred to as chronic obstructive lung disease (COLD) or chronic obstructive airway disease (COAD).
Asthma-COPD overlap syndrome (ACOS) is when you have symptoms of both asthma and chronic obstructive pulmonary disease (COPD). Asthma is a chronic lung disease that causes reversible airway narrowing, inflammation in the airways, and mucus production.
Commonly used spirometry measurements of relevance for the differentiation of asthma from COPD include the volume of air that can be forcibly exhaled in a single breath after a maximum inspiration (forced vital capacity [FVC]), the FEV1 of this maneuver, and the ratio of these measurements (FEV1/FVC).
COPD is worse than asthma. With a well-designed treatment plan, asthma symptoms can be controlled sufficiently to return lung function to normal, or very close to normal, so the condition is generally considered reversible.
When the walls are damaged the alveoli lose their ability to stretch and spring and the air gets trapped. Since the term COPD is unspecified and represents any form of unspecified chronic obstructive lung disease, an additional code is not needed when the diagnosis of emphysema is documented in the healthcare record.
0 is coded first, followed by the code for pneumonia, and assigned to DRG 190 COPD with MCC. AECOPD and Pneumonia: When a patient has both pneumonia and acute exacerbation of COPD, it is appropriate to assign both codes J44. 0 [COPD with acute lower respiratory infection] and J44. 1 [COPD with (acute) exacerbation].
Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema and chronic bronchitis. COPD makes breathing difficult for the 16 million Americans who have this disease.
J44. 1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM J44. 1 became effective on October 1, 2021.
Asthma with COPD is classified to code 493.2x. However, all coding directives in the Tabular List and index need to be reviewed to ensure appropriate code assignment. A fifth-digit sub classification is needed to identify the presence of status asthmaticus or exacerbation.
A diagnosis of COPD and acute bronchitis is classified to code 491.22. It is not necessary to assign code 466.0 (acute bronchitis) with 491.22. Code 491.22 is also assigned if the physician documents acute bronchitis with COPD exacerbation. However, if acute bronchitis is not mentioned with the COPD exacerbation, then code 491.21 is assigned (AHA Coding Clinic for ICD-9-CM, 2008, fourth quarter, pages 241-244).
Exacerbation is defined as a decompensation of a chronic condition. It is also defined as an increased severity of asthma symptoms, such as wheezing and shortness of breath. Although an infection can trigger it, an exacerbation is not the same as an infection superimposed on a chronic condition. Status asthmaticus is a continuous obstructive asthmatic state unrelieved after initial therapy measures.
Chronic obstructive pulmonary disease is a chronic bronchitis alpha-1 antitrypsin deficiency that is a genetic form of emphysema. The disease is most of the time characterized by the narrowing or obstruction of airflow and interference that hinders normal breathing. The primary risk factor for chronic obstructive pulmonary disease is smoking or second hand smoking, heredity and air pollution.
When the acute exacerbation of COPD is clearly identified, it is the condition that will be designated as the principal diagnosis. (AHA Coding Clinic for ICD-9-CM, 1988, third quarter, pages 5-6).
Coding and sequencing for COPD are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care.
You are viewing the 2012 version of ICD-9-CM 493.2.
asthma NEC (see also Asthma) 493.2
asthma NEC (see also Asthma) 493.9
chemical (due to fumes and vapors) 506.4
valve (see also Endocarditis, pulmonary) 424.3
A disease of chronic diffuse irreversible airflow obstruction. Subcategories of copd include chronic bronchitis and pulmonary emphysema.
Signs and symptoms include shortness of breath, wheezing, productive cough, and chest tightness. The two main types of chronic obstructive pulmonary disease are chronic obstructive bronchitis and emphysema. A disease of chronic diffuse irreversible airflow obstruction. Subcategories of copd include chronic bronchitis and pulmonary emphysema.
A chronic and progressive lung disorder characterized by the loss of elasticity of the bronchial tree and the air sacs, destruction of the air sacs wall, thickening of the bronchial wall, and mucous accumulation in the bronchial tree.
The 2022 edition of ICD-10-CM J44.9 became effective on October 1, 2021.
Chronic obstructive pulmonary disease includes chronic bronchitis, in which the bronchi (large air passages) are inflamed and scarred, and emphysema, in which the alveoli (tiny air sacs) are damaged. It develops over many years and is usually caused by cigarette smoking.
COPD ICD 10 codes and guidelines can be found in chapter 10 of ICD-10-CM manual which is “diseases of the respiratory system”, code range J00 – J99
COPD ICD 10 Code list and guidelines 1 As COPD is a group of diseases it is important to see the coding guidelines properly before deciding which code to be assigned. 2 Look for the notes – Excludes 1, excludes 2, includes, code also, use additional. 3 Excludes 1 note has codes from category J43, J41, J42, J47 and J68.0 4 Asthma of specified type (Eg: mild intermittent asthma) should be coded separately along with COPD. 5 Disease – Airway – Obstructive = Leads to COPD
Groups of lung diseases contribute to COPD, most commonly seen combinations are Emphysema and chronic bronchitis. Cigarette smoking is one of the major risk factor in increasing the number of COPD patients in the world.
Diagnosis of COPD can be done by doing pulmonary function test (PFT), chest X-ray, CT lung or arterial blood gas analysis.
Note: asthma unspecified J45.909 can not be coded with COPD. Asthma can be coded only if it is specified to which type.
Can not code J43.9 (emphysema) as it has excludes 1 note for “emphysema with chronic (obstructive) bronchitis (J44.-)
As COPD is a group of diseases it is important to see the coding guidelines properly before deciding which code to be assigned.