Assigning COPD Dx: Not as Simple as It Seems

At first glance, diagnosis coding for chronic obstructive pulmonary disease, more commonly known as COPD, seems like a cinch. ICD-9-CM links “obstructive pulmonary disease [COPD]” to 496 Chronic airway obstruction, not elsewhere classified. Easy!

Except … does that “not elsewhere classified” make you a bit nervous? Aren’t three-digit ICD-9-CM codes usually best avoided due to lack of specificity?

In fact, COPD is a generic term to describe symptoms that may occur as part of another, more specific condition. By the same token, 496 is a catch-all diagnosis, appropriate only when a more precise disease process has not been identified.

Specifically, you shouldn’t report 496 with chronic bronchitis (491.xx), emphysema (492.x), or asthma (493.xx). Just as shortness of breath is “part of” pneumonia, COPD is included within categories 491-493.

In total, there are 24 distinct ICD-9-CM code listings with which you should not list COPD separately. As the ICD-9-CM manual advises, “Due to the overlapping nature of conditions that make up COPD, it is essential that the coder review all instructional notes carefully.”

For example, the physician documentation lists COPD and chronic bronchitis. Proper coding is 491.0 Simple chronic bronchitis because chronic bronchitis is the more specific code, which includes the COPD. If documentation lists COPD and asthma,  you would report 493.2x Chronic obstructive asthma. Per Coding Clinic (Second Quarter 1990, page 20), “When a diagnosis of asthma is documented with COPD, 493.2x is assigned whether or not the physician states ‘chronic obstructive’ asthma. Codes 493.0x, 493.1x, and 493.9x are used to classify asthma in patients without chronic obstructive lung disease.”

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4 Responses to “Assigning COPD Dx: Not as Simple as It Seems”

  1. Keri Campos says:

    Per ICD-9, Asthma with COPD is coded to 493.2x not 493.9x.

    Also per Coding Clinic:

    COPD wtih asthma

    Coding Clinic, Second Quarter 1990 Page: 20 Effective with discharges: April 1, 1990

    Question:

    Please explain the new code 493.2, COPD with asthma. When is this code used? Does the physician have to attest to the diagnosis of obstructive asthma or is it assumed with the presence of COPD?

    Answer:

    The new code 493.2x, Chronic obstructive asthma, is appropriate because of the need to distinguish between nonobstructive and obstructive asthma (that in chronic obstructive lung disease), within the classification. When a patient has COPD with asthma there is continuous obstruction to airflow on expiration, unlike a patient with nonobstructive asthma where the patient wheezes during an asthma attack, but returns to normal breathing once the attack subsides.

    When a diagnosis of asthma is documented with COPD, 493.2x is assigned whether or not the physician states “chronic obstructive” asthma. Codes 493.0x, 493.1x, and 493.9x are used to classify asthma in patients without chronic obstructive lung disease.

  2. Eugenia R. says:

    What about when the physician documents COPD with exacerbration? There is no mention of the patient having bronchitis, no history of bronchitis. In this case 496 should be assigned because in the icd-9-cm instructions are given concerning when to apply 491.21. Basically, bronchitis is to be documented in order to assign 491.21.
    What is your opinion?

  3. Jill Sell-Kruse says:

    Refer to the ICD-9-CM index, Disease, lung, obstructive (chronic) (COPD)
    with
    acute
    exacerbation NEC 491.21

    Bronchitis does not need to be documented in order to assign a code for COPD with exacerbation, 491.21.

  4. Praveen R says:

    How about coding the scenario Acute bronchitis, emphysema and chronic obstructive asthma?

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