Wiki ICD9 Help from a facility coder perspective please

[lindasileo]

Hello, I recently switch from strictly ED Professional services coding to ED Hospital facility coding and am being "trained" again in ICD9 coding. Today I had a case of a patient who presented to the ED with cough and SOB and DX'd with Acute Bronchitis and COPD with acute exacerbation, I coded 491.22. My trainer noted that the patient had a history of Emphysema, (I did miss this), and said the correct codes should be 466.0 and 492.8. I'm questioning these code selections, we use 3M encoder, I went in under Bronchitis, and selected all the criteria to end up with the 491.22 code. My trainer stated that I should have gone in under Emphysema, which gives the choice of acute bronchitis with the COPD. I would like some feedback from this forum if you have the time to read this, my main question is why would I use Emphysema first in 3M??
Thanks in advance!
Frustrated Coder

 

[gouripathare]

The conditions that comprise COPD, are obstructive chronic bronchitis, subcategory 491.2 and Emphysema category 492.
As in this case Emphysema is primary disease, I searched in alphabetic index of ICD 9 for Emphysema. The code for Emphysema with bronchitis with acute bronchitis is 491.22.Under tabular index 491.22 description says when acute bronchitis 466.0 is documented with COPD, code 491.22 shd be assigned.