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Wiki COPD and emphysema

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AudCo2020!

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How is COPD with emphysema coded in ICD 9? I was asked this on an assessment test and it is a bit confusing as far as 491.20 is COPD without exacerbation which is COPD with emphysema with chronic bronchitis. To code it separately 496 states not to be used with any code from categories 491-493. So how is COPD with emphysema correctly coded using ICD 9? Thank you.
 
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