ICD-10 Reminder Series: Chapter 1.C.10 Disease of the Respiratory System


Coding for respiratory disease in ICD-10-CM can be tricky. If you don’t fully know the guidelines, it’s possible that you’re reporting these conditions inaccurately. So let’s dive in and clear things up so you can report as accurately as possible. First, let’s chat about chapter-specific ICD-10-CM guidelines.

Chronic Obstructive Pulmonary Disease and Asthma – Chapter Specific Guideline

  1. The codes in 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.

If you look at the code choice for Chronic Obstructive Pulmonary Disease there is a “Code also” note for reporting the type of asthma, if applicable. But what if the documentation is not clear on the type of asthma, and you’re unable to perform a query? Is unspecified asthma a type of asthma? Is it appropriate to report J44.9 with J45.909? Why is it all so complicated? Have no fear! We can look to Coding Clinic to give us clarity on this scenario:

  • AHA Coding Clinic 2017 Vol 4, Number 1: This coding clinic tells us that it is not appropriate to report unspecified asthma with COPD, as a type is not specified.
  • AHA Coding Clinic 2017 Vol 4, Number 4: This coding clinic tells us that unspecified asthma with acute exacerbation is specifying an acute exacerbated state of asthma so we would report J45.901 along with J44.9 for COPD.

Coding COPD with emphysema. Emphysema is a specified type of COPD and falls in the J43 codes in ICD-10-CM. There is an Excludes 1 Note that implies these codes should not be reported together for emphysema with Chronic obstructive bronchitis (J44.-), but it does not actually say chronic obstructive pulmonary disease. We can look to Coding Clinic to give us clarity in this scenario:

  • AHA Coding Clinic 2017 Vol 4, Number 4: This Coding Clinic tells us to report only Emphysema if COPD and emphysema are both documented in a record, stating Emphysema is a specified type of COPD.

The index will lead you to correct code assignment by:

  • Disease
    • Lung J98.4
    • obstructive (chronic) J44.9
    • with
    • emphysema J43.9

It’s especially important to pay attention and follow the Excludes 1 Note, and code also instructions within the tabular for correct code assignment, as well as AHA Coding Clinic.  Following the ICD-10-CM guidelines and AHA Coding Clinic will ensure you are compliant in code reporting and everyone wins.

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