Keep in mind these coding tips to improve documentation for chronic obstructive pulmonary disease and other associated respiratory conditions

In order to support the ICD-9-CM diagnosis code selected, chronic obstructive pulmonary disease and other associated respiratory conditions need to be properly documented in the medical record.

What’s COPD?
Chronic obstructive pulmonary disease is a common and progressive disease that makes it difficult to breathe. Common symptoms include coughing that produces large amounts of mucus, wheezing, shortness of breath and chest tightness. The two main forms of COPD are emphysema and chronic bronchitis. However, many patients with COPD have both emphysema and chronic bronchitis.

What causes COPD?
Smoking cigarettes is the leading cause of COPD. Most people who have COPD are either current smokers or have a history of tobacco use. Other causes include long-term exposure to lung irritants such as air pollution, chemical fumes and dust, all of which can contribute to COPD.

Tips to remember when coding COPD
When coding for COPD, bronchitis (acute, chronic), asthmatic bronchitis (acute, chronic), emphysema and other associated respiratory conditions, it’s important to properly code whether or not the condition is acute, chronic or in acute exacerbation.

• Due to the overlapping nature of the conditions that comprise COPD, code selection must be based on terms documented by the provider.
• ICD-9-CM code 496, chronic airway obstruction not elsewhere classified, should only be used if the type of COPD being treated is not specified in the medical record.
• If a provider has documented a patient’s status as “status asthmaticus” with any type of COPD or acute bronchitis, the asthmaticus should be sequenced first. (See ICD-9-CM Official Guidelines for Coding and Reporting, 8.a.4 and Coding Clinic, first quarter 2005, page 50).
• It’s imperative to always document and code to the highest specificity. For example, if the provider states “acute bronchitis” or “chronic bronchitis,” then report ICD-9-CM codes 466.x and 491.x, respectively. However if the provider does not indicate whether the bronchitis was either acute or chronic, then the appropriate ICD-9-CM code would be 490: Bronchitis not specified as acute or chronic.
• When COPD with an acute exacerbation is documented without acute bronchitis, then report ICD-9-CM code 491.21: Obstructive chronic bronchitis with (acute) exacerbation.
• Code 491.22 (Obstructive chronic bronchitis with acute bronchitis) when the medical record supports acute bronchitis and COPD. In this case, it will be unnecessary to assign code 466.0 (acute bronchitis).

*This code should not be used with any code from category 491-493.

It’s important to review the ICD-9-CM Coding Guidelines (Chapter 8: Diseases of Respiratory System 460-519), as well as any instructional notes under the various COPD subcategories and codes in the tabular list of the ICD-9-CM manual, in order to select the correct code.