10-12-2017, 06:58 AM | Community Wiki

Results 1 to 5 of 5

Emphysema with COPD

  1. Default Emphysema with COPD
    Medical Coding Books
    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 ?

  2. #2
    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.

  3. #3
    International Member
    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 ..!

  4. Default
    Thank you vJ Tiwari - thats very helpful !

  5. Lightbulb 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.

Similar Threads

  1. Asthma w/emphysema
    By Rachels in forum Diagnosis Coding
    Replies: 1
    Last Post: 01-12-2015, 12:42 PM
  2. Asthma with emphysema
    By mjb5019 in forum Diagnosis Coding
    Replies: 2
    Last Post: 12-24-2014, 06:09 AM
  3. copd/emphysema coding
    By l.davis in forum Diagnosis Coding
    Replies: 0
    Last Post: 03-11-2013, 08:51 AM
  4. COPD exacervation/COPD bronchitis
    By ggparker14 in forum Diagnosis Coding
    Replies: 1
    Last Post: 04-20-2012, 09:48 AM
    By heatherwinters in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 05-09-2008, 08:19 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.