Primary Care Coding Alert

Question: The FP performs a level-four E/M for an established patient. The notes indicate that the patient has chronic obstructive pulmonary disease (COPD). The diagnosis coding for COPD confuses me: What separates the different COPD ICD-9 codes? North Carolina Subscriber Answer: The correct code will depend on whether or not the patient had a specified exacerbation along with the COPD diagnosis. Report 491.21 (Obstructive chronic bronchitis; with [acute] exacerbation) for patients diagnosed with COPD who have had an exacerbation. Report 491.20 (Obstructive chronic bronchitis; without exacerbation) for patients diagnosed with COPD classified as obstructive chronic "bronchitis" by the physician in the documentation/ medical record, but without an exacerbation. When the COPD is not otherwise specified, report 496 (Chronic airway obstruction, not elsewhere classified). Suppose the FP indicates that the patient has obstructive bronchitis. On the claim, link 491.20 to 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key elements: a detailed history; a detailed examination; medical decision-making of moderate complexity).