 CODING FOR CHRONIC
OBSTRUCTIVE PULMONARY
DISEASE……… ................
1
 COPD CONT.……… .... 2
 DID YOU KNOW ? …… ... 2
Risk Adjustment and
Coding Academy
Coding | Risk Adjustment | Documentation | Training

ON THE HORIZON: HEALTH
CARE LAW SAVES 3.9 BILLION
ON PRESCRIPTION DRUGS FOR
PEOPLE WITH
MEDICARE………………2
Coding
Insight
Vol. 5 Aug. 2012
Coding for Chronic Obstructive Pulmonary Disease
Understanding the Significance
Approximately 24 million people in the
United States live with Chronic Obstructive
Pulmonary Disease (COPD), with roughly 12
million remaining undiagnosed. In 2008,
COPD became the third leading cause of
death in America. COPD is responsible for
one death every four minutes, averaging
more than breast cancer and diabetes
combined. The estimated cost of COPD in
2010 was $49.9 billion.
Documentation is Vital
COPD refers to a group of diseases that
cause airflow blockage and breathingrelated problems. The diseases
incorporated with COPD include
emphysema, bronchitis, and in some cases
asthma. It is important to understand the
coding implications when two or more of
these conditions exist. Also consider
whether the condition is acute, chronic, or
exacerbated.
When reviewing the medical record,
identify supporting documentation for the
diagnosis of COPD such as the following
symptoms: diffuse wheezing, diminished
breath sounds, prolonged expiration, rales,
dyspnea, breathlessness, tachypnea, and
chronic productive cough. Also, look for
tests such as a chest X-ray, pulse oximetry,
spirometer, and pulmonary function test.
Coding for COPD
Code 496 (chronic airway obstruction, not
elsewhere classified) is only to be used
when the documentation does not specify
the type of COPD and there is not a more
specific code to assign.
The three conditions that incorporate COPD
are obstructive chronic bronchitis
(subcategory 491.2x), emphysema (category
492.x), and asthma (subcategory 493.2x).
Per ICD-9 coding guidelines, code 496 is not to
be used with any code from categories 491493.
Coding Tips...
•
Per ICD-9 coding
guidelines, code 496 is
not to be used with any
code from categories 491493.
•
For COPD unspecified,
code 496
•
For emphysema with
chronic bronchitis, code
491.20
•
For COPD with
exacerbation, code
491.21
•
For COPD with acute
bronchitis, code 491.22
•
For COPD with
emphysema, code 492.8
•
For COPD with
unspecified asthma, code
493.20
•
For COPD with
hypoxemia, code 799.02
and 496
COPD Exacerbation
According to the Global Initiative for
Obstructive Lung Disease (GOLD), a COPD
exacerbation is defined as “an event in the
natural course of the disease characterized by
a change in the patient’s baseline dyspnea,
cough, and/or sputum, that is beyond normal
day-to-day variations, is acute in onset and
may warrant a change in medication in a
patient with underlying COPD.” The two main
causes of COPD exacerbation are infection of
the airways or lungs and air pollution.
COPD with exacerbation is classified to code
491.21, which may also include the following
descriptions: acute exacerbation of COPD,
obstructive chronic bronchitis with (acute)
exacerbation, COPD in exacerbation, severe or
or end-stage COPD in exacerbation,
decompensated COPD with or without
exacerbation.
Bronchitis
Bronchitis is an inflammation of the lining of
the bronchial tubes, which carry air to and
from your lungs. When bronchitis is
documented with COPD, assign code 491.20
(obstructive chronic bronchitis without
exacerbation).
Y0071_12_16140_I_10/25/2012
COPD coding cont…
Hypoxemia
Acute bronchitis, code 466.0, is
generally due to an infectious
organism. When acute
bronchitis is documented with
COPD, assign code 491.22
(obstructive chronic bronchitis
with acute bronchitis). It is
unnecessary to also code 466.0.
In addition, code 491.22
includes acute bronchitis with
COPD in acute exacerbation. The
exacerbation of COPD is
superseded by the acute
bronchitis.
Emphysema
Emphysema is a progressive
disease of the lungs that
primarily causes shortness of
breath. When emphysema with
COPD is documented assign
code 492.8, other emphysema.
When emphysema is
documented with chronic
bronchitis, assign a code from
subcategory 491.2x.
Asthma
Asthma is a chronic
inflammatory disease of the
airways characterized by
variable and recurring
symptoms, reversible airflow
obstruction, and bronchospasm.
When the diagnosis of asthma
and COPD are documented,
assign a code from subcategory
493.2x, chronic obstructive
asthma. The fifth digit
classification for 493.2x are “0”
for unspecified, “1” with status
asthmaticus, and “2” with
(acute) exacerbation.
ICD-9-CM Official Coding Guidelines 2012
http://www.primaris.org/sites/default/files/resourc
es/HPMP/coding%20guidelines%20booklet_DRG
_088.pdf
www.wikipedia.com
http://blog.copdfoundation.org/tag/research/
www.goldcopd.org
Hypoxemia is defined as
deficient oxygenation of the
blood. Per ICD-9 coding
guidelines, hypoxemia (799.02)
is not inherent in COPD (496)
and may be assigned in addition
if applicable. There are various
guidelines and instructional
notes throughout the ICD-9-CM
book regarding code
assignment for COPD. It’s
important to review all notes to
warrant accurate coding.
Test Your Knowledge
1. Patient arrives with
shortness of breath. After
examination and review of lab
results, the diagnosis is COPD.
What code(s) would you use?
________________
2. Patient with COPD is being
admitted to the hospital due to
asthma with acute
exacerbation.
What code(s) would you use?
___________________
3. In addition to COPD, hypoxia
is documented.
What code(s) would you use?
___________________
4. Patient has acute
exacerbation of COPD.
What code(s) would you use?
Answers:
1.
2.
3.
4.
496
493.22
799.02, 496
491.21
On the Horizon…
HEALTH CARE LAW SAVES $3.9
BILLION ON PRESCRIPTION DRUGS
FOR PEOPLE WITH MEDICARE
The Centers for Medicare & Medicaid
Services (CMS) announced that as a result
of the Affordable Care Act, over 5.2 million
seniors and people with disabilities have
saved over $3.9 billion on prescription
drugs since the law was enacted. The
Centers for Medicare & Medicaid Services
(CMS) also released data July 25, 2012
showing that in the first half of 2012, over
1 million people with Medicare saved a
total of $687 million on prescription drugs
in “donut hole” coverage gap for an
average of $629 in savings this year.
For more information regarding
savings on prescription drugs for
people with Medicare, please visit:
http://www.cms.gov/apps/media/pre
ss/release.asp?Counter=4412&intNu
mPerPage=10&checkDate=&check
Key=&srchType=1&numDays=350
0&srchOpt=0&srchData=&keyword
Type=All&chkNewsType=1%2C+2
%2C+3%2C+4%2C+5&intPage=&s
howAll=&pYear=&year=&desc=&c
boOrder=date
Y0071_12_16140_I_10/25/2012