COPD Diagnosis

[melheffley]

We have a coding dispute in our office. Our internal med physician diagnosed a patient with COPD w/ exacerbation. One part of the office feels that the correct DX for this would be 496 (chronic airway obstruction, not elsewhere classified), since we were provided with no other information. Another part of the office, however, believes that the correct DX is 491.21 (obstructive chronic bronchitis, with acute exacerbation) whenever it states exacerbation. Can someone please give your opinion on what the correct coding would be? Thank you.

[yabbott]

I use 491.21 for COPD with exacerbation. If you look at the description under the code it states Acute exacerbation of chronic obstructive pulmonary disease.

[dmaec]

491.21 has my vote... it's what I use when there is COPD with exacerbation.
I agree with "another part of the office"
if you follow the index volume 2, through the volume 1 - it's the correct code.
{that's my opinion on the posted matter}

[TB RNCPC]

If the only information documented is "COPD with exacerbation", how can we make the assumption the patient has obstructive bronchitis with acute exacerbation (491.21)? COPD with exacerabation could be caused by any disorder marked by persistent obstruction of bronchial air flow. Without any additional documentation, I choose 496. (COPD NOS)
What is confusing without any addtional documentation is that it could be 491.21 or 493.22.
Just my thought.

[Lisa Bledsoe]

Based on the description of 491.21 "acute exacerbation of COPD" I don't think we are making any assumptions. It's right there in black and white.

[dmaec]

TB RNCPC
because that's "all" it said was - "COPD w/ exacerbation" <-- that is why we can conclude it's COPD - hence 491.21. Note the brackets [COPD] under the 491.21 listing in volume 1. (chronic obstructive pulmonary disease [COPD]) That means 491.21 "is" COPD with exacerbation.
it even makes a note as to where to look "if" it's chronic obstructive asthma -
Nothing is stated about asthma -it didn't say chronic obstructive asthma with COPD.

I'd still code a dx of "COPD w/exacerbation" as 491.21 (unless otherwise stated as asthma).
{that's my opinion on the posted matter}

[melheffley]

I guess what is so confusing is that 491.21 is under the sub-category of 491--Chronic bronchitis. I was taught sub-divided items under that (codes with 4th or 5th digits etc) still pertained to the initial condition at the top, in this case being Chronic Bronchitis. With out knowing more details, as to whether the patient has bronchitis, asthma or emphysema why do we assume that the patient has chronic bronchitis? Could someone give an example of when 496 would be appropriate and why?

[dmaec]

I use 496, when the dx is COPD - (no mention exacerbation or asthma). When there's no other mention of anything other than COPD - that's when I use the 496.

in the index - you have to read further and "see other"..asthma, bronchitis, etc... if you follow those instructions and looked under asthma you would see your intital dx doesn't support it - however, if you followed the instructions and looked under bronchitis - it would lead you to COPD w/exacerbation to 491.21 - and if you go to volume 2 and read further - you'll be sure - COPD w/exacerbation is indeed 491.21.

also note on the page in volume 1 - it has a little example of how COPD 496/ Chronic Bronchitis 491/ and Emphysema 492/ interrelate - it's why COPD w/exacerbation turns into a dx with "bronchitis"..

[rmwinder]

If all you have is COPD w/ exacerbation, and that's the only description you have (exacerbation), no mention of bronchitis or emphysema or asthma, it is 491.21. To get any other diagnosis, you'd need clarification on it, you'd have to query the physician as to exactly the type of COPD.

[LA929]

It may help to know the definition of COPD and what it includes. The American Lung Association defines COPD as:

"Chronic obstructive pulmonary disease (COPD) is a term referring to two lung diseases, chronic bronchitis and emphysema, that are characterized by obstruction to airflow that interferes with normal breathing. Both of these conditions frequently co-exist, hence physicians prefer the term COPD. It does not include other obstructive diseases such as asthma."

That should help to take away some of the concern about the word bronchitis. I agree with the other's that the correct code is 491.21.

HTH