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
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 ?
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