Wiki Emphysema with COPD

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Code: J43.9

Code Name: ICD-10 Code for Emphysema, 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: Emphysema, unspecified
Bullous emphysema (lung)(pulmonary)
Emphysema (lung)(pulmonary) NOS
Emphysematous bleb
Vesicular emphysema (lung)(pulmonary)

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)

Excludes1: compensatory emphysema (J98.3)
emphysema due to inhalation of chemicals, gases, fumes or vapors (J68.4)
emphysema with chronic (obstructive) bronchitis (J44.-)
emphysematous (obstructive) bronchitis (J44.-)
interstitial emphysema (J98.2)
mediastinal emphysema (J98.2)
neonatal interstitial emphysema (P25.0)
surgical (subcutaneous) emphysema (T81.82)
traumatic subcutaneous emphysema (T79.7)

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 J43.9, ICD-10 Code for Emphysema, unspecified , visit:


Best answers
When emphysema and COPD exist in the same patient, it has always been my understanding that one would code only emphysema, 492.8.

1. "Emphysema" in the index [which includes the optional terms (chronic) and (obstructive)] codes to 492.8. There is no entry for "with COPD" under this heading. There IS an entry for "with bronchitis, chronic 491.20" but "COPD" is not the same thing as "chronic bronchitis."
2. When one codes COPD as 496, it notes that the code is not to be used with any code from categories 491-493, and that it specifically excludes emphysema (492.0-492.8). There is no mention that emphysema with COPD should be specially coded in any other way.

The Coders' Desk Reference for Diagnoses states, as the last paragraph under "492 Emphysema":
Emphysema stated as "with chronic bronchitis" or "chronic obstructive pulmonary disease" is assigned the appropriate code from the 491.20-491.21 range.

(I find the placement of the quotation marks in this sentence awkward and somewhat confusing.)

491.20 does include "Epmhysema with chronic bronchitis." As previously stated, however, "chronic bronchitis" is not the same thing as "COPD."

A three-circle Venn diagram appears in the area of the 491 codes in ICD-9-CM Expert for Hospitals (2010 edition). In this diagram, three circles overlap. These circles are labeled:
Chronic Airway Obstruction (COPD, NOS) 496
Emphysema 492
Chronic Bronchitis 491

Where the circles overlap, the area is shaded, as is standard in a Venn diagram.
A note beside the diagram indicates:
Shaded area: Obstructive Chronic Bronchitis (Chronic Bronchitis with COPD) 491.20-491.21

The diagram and the CDR do seem to indicate that Emphysema with COPD should be coded as 491.20; but the text of the ICD-9 seems to state that it should be 492.8, which I (and my colleagues) have been coding as such for years.

The question is: what is the correct way to code Emphysema with COPD ?


Best answers
I always coded it the way you do but just recently have been told that it is the 491.20 due to the fact that they are both chronic and the 491.20 encompasses 492.8.

On another note w/ the same thought process: Is it ever okay to code just a 496? I have been told not to use it and that in place it should be 491.20.


International Member
Best answers
When you refer Index of diseases, (also with tabular list)

Then under Diseases - -> Lung - -> Obstructive --> emphysema => 492.8
So i.e. COPD + emphysema = 492.8

Now, When you've COPD with acute excerbation + emphysema => 491.21.

COPD with acute Bronchitis + emphysema => 491.22.

COPD with chronic Bronchitis + emphysema => 491.20.

I think that's the way is ..!


Best answers
S. Parlor CPC

According to 2018 Coding Updates. (April issue of Business Monthly-AAPC) pg. 56

"When both Emphysema and COPD are documented, assign code J43.9."

because emphysema is a specific type of COPD.