Wiki COPD Diagnosis

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Code: J44.9

Code Name: ICD-10 Code for Chronic obstructive pulmonary disease, unspecified

Block: Chronic lower respiratory diseases (J40-J47)

Excludes 1:bronchitis due to chemicals, gases, fumes and vapors (J68.0)

Excludes 2: cystic fibrosis (E84.-)

Details: Chronic obstructive pulmonary disease, unspecified
Chronic obstructive airway disease NOS
Chronic obstructive lung disease NOS

Code also: type of asthma, if applicable (J45.-)

Use additional code to identify:exposure to environmental tobacco smoke (Z77.22)
history of tobacco dependence (Z87.891)
occupational exposure to environmental tobacco smoke (Z57.31)
tobacco dependence (F17.-)
tobacco use (Z72.0)

Includes: asthma with chronic obstructive pulmonary disease
chronic asthmatic (obstructive) bronchitis
chronic bronchitis with airways obstruction
chronic bronchitis with emphysema
chronic emphysematous bronchitis
chronic obstructive asthma
chronic obstructive bronchitis
chronic obstructive tracheobronchitis

Excludes1: bronchiectasis (J47.-)
chronic bronchitis NOS (J42)
chronic simple and mucopurulent bronchitis (J41.-)
chronic tracheitis (J42)
chronic tracheobronchitis (J42)
emphysema without chronic bronchitis (J43.-)

Excludes2: lung diseases due to external agents (J60-J70)

Guidelines: Diseases of the respiratory system (J00-J99)
Use additional code, where applicable, to identify:exposure to environmental tobacco smoke (Z77.22)
exposure to tobacco smoke in the perinatal period (P96.81)
history of tobacco use (Z87.891)
occupational exposure to environmental tobacco smoke (Z57.31)
tobacco dependence (F17.-)
tobacco use (Z72.0)

Note: When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).

Excludes 2: certain conditions originating in the perinatal period (P04-P96)
certain infectious and parasitic diseases (A00-B99)
complications of pregnancy, childbirth and the puerperium (O00-O9A)
congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
endocrine, nutritional and metabolic diseases (E00-E88)
injury, poisoning and certain other consequences of external causes (S00-T88)
neoplasms (C00-D49)
smoke inhalation (T59.81-)
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

For more details on J44.9, ICD-10 Code for Chronic obstructive pulmonary disease, unspecified , visit:


Caledonia, OH
Best answers
We have a coding dispute in our office. Our internal med physician diagnosed a patient with COPD w/ exacerbation. One part of the office feels that the correct DX for this would be 496 (chronic airway obstruction, not elsewhere classified), since we were provided with no other information. Another part of the office, however, believes that the correct DX is 491.21 (obstructive chronic bronchitis, with acute exacerbation) whenever it states exacerbation. Can someone please give your opinion on what the correct coding would be? Thank you.

I use 491.21 for COPD with exacerbation. If you look at the description under the code it states Acute exacerbation of chronic obstructive pulmonary disease.
491.21 has my vote... it's what I use when there is COPD with exacerbation.
I agree with "another part of the office" ;)
if you follow the index volume 2, through the volume 1 - it's the correct code.
{that's my opinion on the posted matter}
If the only information documented is "COPD with exacerbation", how can we make the assumption the patient has obstructive bronchitis with acute exacerbation (491.21)? COPD with exacerabation could be caused by any disorder marked by persistent obstruction of bronchial air flow. Without any additional documentation, I choose 496. (COPD NOS)
What is confusing without any addtional documentation is that it could be 491.21 or 493.22.
Just my thought.:)
because that's "all" it said was - "COPD w/ exacerbation" <-- that is why we can conclude it's COPD - hence 491.21. Note the brackets [COPD] under the 491.21 listing in volume 1. (chronic obstructive pulmonary disease [COPD]) That means 491.21 "is" COPD with exacerbation.
it even makes a note as to where to look "if" it's chronic obstructive asthma -
Nothing is stated about asthma -it didn't say chronic obstructive asthma with COPD.

I'd still code a dx of "COPD w/exacerbation" as 491.21 (unless otherwise stated as asthma).
{that's my opinion on the posted matter}
I guess what is so confusing is that 491.21 is under the sub-category of 491--Chronic bronchitis. I was taught sub-divided items under that (codes with 4th or 5th digits etc) still pertained to the initial condition at the top, in this case being Chronic Bronchitis. With out knowing more details, as to whether the patient has bronchitis, asthma or emphysema why do we assume that the patient has chronic bronchitis? Could someone give an example of when 496 would be appropriate and why?
I use 496, when the dx is COPD - (no mention exacerbation or asthma). When there's no other mention of anything other than COPD - that's when I use the 496.

in the index - you have to read further and "see other"..asthma, bronchitis, etc... if you follow those instructions and looked under asthma you would see your intital dx doesn't support it - however, if you followed the instructions and looked under bronchitis - it would lead you to COPD w/exacerbation to 491.21 - and if you go to volume 2 and read further - you'll be sure - COPD w/exacerbation is indeed 491.21.

also note on the page in volume 1 - it has a little example of how COPD 496/ Chronic Bronchitis 491/ and Emphysema 492/ interrelate - it's why COPD w/exacerbation turns into a dx with "bronchitis"..
If all you have is COPD w/ exacerbation, and that's the only description you have (exacerbation), no mention of bronchitis or emphysema or asthma, it is 491.21. To get any other diagnosis, you'd need clarification on it, you'd have to query the physician as to exactly the type of COPD.
It may help to know the definition of COPD and what it includes. The American Lung Association defines COPD as:

"Chronic obstructive pulmonary disease (COPD) is a term referring to two lung diseases, chronic bronchitis and emphysema, that are characterized by obstruction to airflow that interferes with normal breathing. Both of these conditions frequently co-exist, hence physicians prefer the term COPD. It does not include other obstructive diseases such as asthma."

That should help to take away some of the concern about the word bronchitis. I agree with the other's that the correct code is 491.21.