The First Quarter 2019 Coding Clinic responded to several questions in regard to which codes to report for when you have codes from both categories J43 Emphysema and J44 Other Chronic Obstructive Pulmonary Disease. The table below summarizes the clinical scenarios submitted, code recommendations and rationale.
| Presenting Problem | Medical History | Coding Clinic Response | Rationale |
|---|---|---|---|
| COPD Exacerbation | COPD Emphysema | Assign only: J43.9 Emphysema |
The Excludes 1 note found at category J44 prohibits reporting J44.1 with J43.9 |
| Acute Bronchitis and COPD | COPD Emphysema | Assign codes: J20.9 Acute Bronchitis J43.9 Emphysema |
The Excludes 1 note found at category J44 prohibits reporting J44.0 with J43.9 |
| Pneumonia COPD |
Emphysema | Assign codes: J18.9 Pneumonia NOS J43.9 Emphysema |
The Excludes 1 note found at category J44 prohibits reporting J44.0 with J43.9 |
| Asthma COPD |
Emphysema | Assign codes: J45.xx Specific Asthma J43.9 Emphysema |
The Excludes 1 note found at category J44 prohibits reporting J44.9 with J43.9 |
The current version of ICD-10-CM requires identifying the specificity of the type of COPD by reporting J43.9 Emphysema over using specific codes from category J44 COPD that more accurately captures the acuity of the patient’s condition. Most of the responses included that an instructional note revision should be proposed for discussion during a future ICD-10-CM Coordination and Maintenance Committee meeting. We reviewed the Diagnosis Agenda for the March 5 – 6, 2019 meeting and this item was not included which makes it unlikely that this issue will be resolved with 10/1/19 updates. However, continued close monitoring is required based on the frequency in reporting these diagnosis codes and the potential to impact DRG, reimbursement and case mix index.
Reference First Quarter 2019 Coding Clinic, Pages 34 – 37.