Pulmonology Coding Alert

Did you remember how to report eosinophilic asthma?

Check your work to see if your answers from the quiz questions on page 3 match up with the ones provided below.

Show Cause and Effect for J45.-

Answer 1: For this scenario, you’ll assign J45.31 (Mild persistent asthma with (acute) exacerbation) and J30.1 (Allergic rhinitis due to pollen) to report the patient’s acute exacerbation of asthma due to hay fever. ICD-10-CM code J30.1 features an additional synonym of “hay fever,” so you can assign this code the specify the cause of the patient’s exacerbated asthma.

The J45.- (Asthma) parent code features an Includes note that contains “hay fever with asthma,” but the descriptor for J45.901 (Unspecified asthma with (acute) exacerbation) doesn’t paint the full picture of the patient’s condition. “The exacerbation must be described and linked to the hay fever, and a separate code for the hay fever should be reported. Providers should always document cause-and-effect, and be as specific as possible,” says Sheri Poe Bernard, CPC, CRC, CDEO, CCS-P, CPC-I, managing consultant at Granite GRC Consulting and CEO of Prestige CEUs in Salt Lake City, Utah.

At the same time, the codes in the J45.- category require 4th and 5th characters to complete each code. The additional characters allow you to specify a variety of other factors related to the patient’s condition. “Providers should document asthma by its severity, chronicity, and presence of exacerbation or status asthmaticus (asthma that isn’t resolved with medications),” Bernard says.

Don’t Forget the ‘Ex’ in Extrinsic Asthma

Answer 2: Extrinsic asthma is also known as allergic asthma, which means that the patient is diagnosed with asthma that’s caused by an allergic reaction — particularly a chronic allergic reaction. Intrinsic asthma is nonallergic asthma and is triggered by several nonallergic factors, such as cold or dry air, stress, smoke, anxiety, and more.

Another way to remember the difference between extrinsic and intrinsic asthma is to note where the trigger is located. Intrinsic asthma is activated by internal mechanisms, while extrinsic asthma is caused by an allergic reaction to an external force.

If you’re coding a report with a diagnosis of extrinsic allergic asthma or intrinsic nonallergic asthma, you’ll assign a code from the J45.- category. The parent code features an Includes note that contains extrinsic allergic asthma and intrinsic nonallergic asthma synonyms.

Parent code J45.- also features instructions to use an additional code to identify the trigger of the asthma exacerbation. “If there is an exacerbation, providers must identify the cause. This will require two codes: one to specify the type of asthma and one for the allergy or other cause of exacerbation,” Bernard says.

For example, if your provider evaluated a patient with moderate persistent asthma experiencing an exacerbation due to a peanut allergy, then you’ll assign two codes for the diagnosis. The codes you’d assign would be J45.41 (Moderate persistent asthma with (acute) exacerbation) and Z91.010 (Allergy to peanuts).

On the other hand, if the same patient was experiencing an exacerbation of their asthma due to acute bronchitis from a parainfluenza virus infection, then you’d assign J20.4 (Acute bronchitis due to parainfluenza virus) as the second code.

Understand the Trick to Coding a Common Form of Asthma

Answer 3: “A common form of asthma that isn’t talked about a lot is eosinophilic asthma, a condition in which the number of eosinophils (type of white blood cell) are increased in the blood and lung tissue,” Bernard says. Eosinophils fight infections and invading bacteria as part of the body’s immune system. However, white blood cells (WBCs) in patients with eosinophilic asthma cause swelling in the body’s airways and respiratory system as well as inflammation. As the levels of eosinophils rise, the asthma symptoms become more severe. Since eosinophilic asthma occurs due to internal forces, “eosinophilic asthma would be considered an intrinsic form of asthma,” Bernard says.

Take, for example, a patient diagnosed with moderate persistent asthma, with acute exacerbation and eosinophilic asthma. Moderate persistent asthma is an advanced type of asthma where the patient experiences wheezing and coughing symptoms every day, which disrupt the patient’s daily life and present sleeping difficulties. You’ll assign two ICD-10-CM codes — J45.41 and J82.83 (Eosinophilic asthma).

Sequencing tip: When you assign J82.83 to report eosinophilic asthma, you’ll find a Code first note that instructs you to initially code the type of asthma. You’ll need to select the applicable asthma code from the J45.- category before J82.83 to correctly report the patient’s diagnosis.

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