Wiki Two supported COPD-type codes w Excludes1 notes. Keep what, remove what & why?

[pallwardt]

We have J41.1 (mucopurulent chronic bronchitis) and J44.1 (COPD exacerbation) on an outpatient record with support for each on this date of service. With the ICD-10 excludes 1 notes, which code do we keep, which do we remove, and why? We do NOT have the option to query the provider.

Any guidance would be appreciated.

Thank you,

Peggy

 

[Bernadette10]

I had this same question. This is what I found, and I'm still confused. If I understand correctly, we should code emphysema unless the patient also has chronic bronchitis, in which case we should code J44.x. I hope someone else will weigh in. The guidelines really should be more clear on this. In your case I would code J44.1 since the patient also has chronic bronchitis.

https://www.aapc.com/blog/41637-clarify-updates-to-diagnosis-coding-of-pulmonary-diseases/

COPD and Emphysema​

Emphysema is defined by Brunner and Suddarth’s Medical-Surgical Nursing (12th edition) as excessive loss of elastic lung recoil. It’s a pathologic term that describes an abnormal distention of the air spaces beyond the terminal bronchioles and destruction of the walls of the alveoli.
When both COPD and emphysema are documented, assign J43.9 Emphysema, unspecified because emphysema is a specific type of COPD.

COPD Exacerbated and Emphysema​

Per Coding Clinic, a diagnosis of emphysema with acute exacerbation of COPD should be coded as J43.9. Categories J44 Other chronic obstructive pulmonary disease and J43 Emphysema include mutual Excludes1 notes; and emphysema without mention of chronic bronchitis falls into category J43. COPD is not synonymous with chronic bronchitis; therefore, COPD exacerbation with emphysema is reported J43.9, rather than a code from category J44.

COPD, Emphysema, and Chronic Bronchitis​

Assign J44.9 for emphysema with chronic bronchitis. Category J44 includes chronic bronchitis with emphysema.

 

[tmckean2]

If the provider documents both COPD and Emphysema as active diagnoses with the new 2024 ICD 10 updates removal of the Excludes 1 notes, how do we precede with coding this now? Do we still code Emphysema as the more specified code? or code them both?

 

[LisaAlonso23]

If the provider documents both COPD and Emphysema as active diagnoses with the new 2024 ICD 10 updates removal of the Excludes 1 notes, how do we precede with coding this now? Do we still code Emphysema as the more specified code? or code them both?

You would only code the Emphysema in this case.