ED Coding and Reimbursement Alert

Question: A patient who has had COPD for nine years presented to our ED with serious difficulty breathing. Upon examination, the ED physician found a collection of mucus in the patient's throat. She had the patient use an Acapella device to expel the mucus so it didn't get caught in his throat anymore. The patient brought up the phlegm and his breathing became clearer. Which diagnosis codes apply?

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Answer: Although this scenario sounds like it would require multiple codes, in this situation, just one code should do the trick: you'll report J44.1 (Chronic obstructive pulmonary disease with [acute] exacerbation). The heading for J44 in the ICD-10 manual states that the code includes "chronic bronchitis with airway obstruction," which this patient has. The reason you'll bill a code that refers to an acute exacerbation is because the airway obstruction is an exacerbation of the COPD condition.