Keep these coding tips for airway-related conditions in mind to improve medical record documentation

This is part of an ongoing series of articles on coding tips.

The overlap in terminology used to define airway-related conditions, such as chronic obstructive pulmonary disease, asthma, emphysema and chronic bronchitis, can often be confusing. The appropriate terminology for these conditions can best be determined through the careful use of the ICD-9-CM Alphabetic Index.

Two particularly challenging conditions for coders are COPD and asthma. Although both share airway obstruction as a common feature, they’re at different ends of the clinical spectrum. However, the two conditions may overlap in many patients late in life.

Asthma often develops during childhood and can cause temporary airway obstruction. It’s often caused by allergies, too. In contrast, COPD usually develops later in life, is often related to smoking, and causes permanent airway obstruction. The two main forms of COPD are emphysema and chronic bronchitis. Asthma and COPD can often overlap, especially in elderly patients who might be affected by both diseases.

In 1990, a new subclassification was created for this condition, called chronic obstructive asthma (493.2X). Other nomenclature for this condition includes asthma with COPD and chronic asthmatic bronchitis. The condition can also be reported whenever a diagnosis of asthma is documented with COPD, whether or not the provider documents chronic obstructive asthma (Coding Clinic, 2Q, 1990, pg. 20).

Careful attention should be paid to documentation for a patient with a form of COPD and asthma. Here’s an example of how to assign documentation codes for a patient who is affected by both conditions:

Assessment

• Acute exacerbation of COPD
• Acute bronchitis
• Acute exacerbation of asthma

Report diagnosis code 491.22 for the acute exacerbation of COPD with acute bronchitis. Assign code 493.22 for the acute exacerbation of asthma.

There’s a note under subclassification 491.21 (obstructive chronic bronchitis with acute exacerbation) that excludes chronic obstructive asthma with acute exacerbation. In this case, the note indicates that the terms excluded from the code are to be coded elsewhere.

The asthma category includes the following codes:

A fifth digit is required for subcategories 493.0, 493.1, 493.2 and 493.9. The fifth digits for asthma include:

According to the ICD-9-CM guidelines, acute exacerbation of asthma is an increased severity of the asthma symptoms, such as wheezing and shortness of breath. Status asthmaticus is defined as a patient’s failure to respond to therapy administered during an asthmatic episode and is a life-threatening complication that requires emergency care.

Coding guidelines also indicate that if status asthmaticus is documented by the provider with any type of COPD or with acute bronchitis, the status asthmaticus should be listed first.

For more information about coding COPD, refer to the November 2013 Record article.

If you have any questions, please contact your provider consultant.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with applicable state and federal laws and regulations.