OPD (Chronic Obstructive Pulmonary Disease) is an umbrella term for lung diseases that make breathing difficult. This difficulty arises from blockage or narrowing of the airways. The two most common types are emphysema and chronic bronchitis, which often occur together. Smoking is the leading cause of COPD. While there’s no cure, measures can be taken to slow its progression.
Emphysema specifically targets the tiny air sacs (alveoli) and airways (bronchioles) in the lungs. These structures lose their elasticity, causing the lungs to become hyperinflated and making it hard to exhale. Trapped air reduces the exchange of oxygen and carbon dioxide (gas exchange). In severe cases, some areas of the lung become thin and bulging, forming what’s called a bulla (larger than 1 cm) or bleb (smaller than 1 cm). These damaged areas cannot heal and risk rupturing, leading to a collapsed lung (spontaneous pneumothorax).
People with emphysema experience shortness of breath and abnormal blood gas levels. Smoking is the leading cause, but a genetic condition can also be responsible. Doctors can further classify emphysema based on the affected lung areas (panlobular or centrilobular, for example using J43 codes), but this distinction is often not crucial for daily care.
Chronic Bronchitis vs. Asthma: Understanding the Differences
This passage clarifies the distinctions between chronic bronchitis and asthma, two respiratory conditions that can overlap.
- Chronic Bronchitis: This condition inflames and thickens the lining of the airways (trachea, bronchi, and bronchioles), leading to increased mucus production and difficulty breathing. A persistent cough with mucus for at least 3 months in a year for 2 years is a hallmark symptom. The type of mucus (clear, purulent, or mixed) can vary. Changes in color or amount may indicate an infection or worsening.
- Asthma: While chronic, asthma differs from COPD. It’s caused by airway inflammation and muscle tightening (bronchoconstriction), often triggered by allergens, pollutants, or exercise. Symptoms like wheezing and shortness of breath typically improve quickly with medication.
Coding Confusion: COPD and Asthma
The current coding system seems flawed:
- Excludes1 for chronic bronchitis (J41.-) with COPD: Chronic bronchitis is a specific type of COPD, not a separate condition. The coding should allow specifying the type (J44.0 or J44.1) within COPD.
- J44.9 (COPD, unspecified): This code is used when the doctor isn’t sure about the specific type of COPD. However, “unspecified” should only apply to disease state (acute or chronic) and not type. If an infection or exacerbation is present, the appropriate code (J44.0 or J44.1) should be used.
- J44.89 (Other specified chronic obstructive pulmonary disease) for “asthma in a patient with COPD”: This is illogical. A patient can have both conditions concurrently. It’s like a child with asthma who develops chronic bronchitis due to smoking. These are separate diagnoses. Separating the contribution of each condition during an exacerbation might be difficult.
The Issue with “Unspecified”
The coding system seems to treat “unspecified” differently for COPD and asthma:
- COPD: “Unspecified” refers only to disease state (acute/chronic) in COPD, not type.
- Asthma: The coding clinic says “unspecified” isn’t a type of asthma. However, “moderate persistent asthma” isn’t a specific type either, unlike “cough-variant asthma.”
The Point:
COPD is an umbrella term encompassing specific conditions like emphysema and chronic bronchitis. “Unspecified” in COPD coding should only indicate disease state, not type. Similarly, for asthma, “unspecified” shouldn’t be considered a type.
COPD Coding:
Specificity Matters:
- If you know the specific type of COPD (emphysema or chronic bronchitis), use the appropriate code (e.g., J44.1 for chronic bronchitis). Chronic bronchitis can be further categorized based on mucus type (simple, mucopurulent, mixed).
- If the COPD is accompanied by a lower respiratory infection or an acute exacerbation, use an additional code to indicate that status (e.g., J44.0 for COPD with acute exacerbation).
- If no specific type or status is documented, use J44.9 (COPD, unspecified).
Asthma and COPD:
- For patients with both asthma and COPD (without COPD type specified), use J44.89 (Other specified chronic obstructive pulmonary disease).
- Similar to COPD alone, use additional codes for infection, exacerbation (J44.0 or J44.1), and asthma details (severity, type – intermittent/persistent, status – uncomplicated/exacerbation/asthmaticus).
Remember: “Other specified” codes represent multiple conditions. Specifying asthma details provides valuable information.
Key Takeaway: Use “as many codes as needed” to accurately capture a patient’s condition. Combining COPD and asthma coding is a prime example.
New Anti-Diabetic Medication Coding:
The question regarding Z79 codes for newly prescribed long-term diabetic medication depends on the setting:
- Facility evaluating for stroke with new-onset diabetes medication: Z79 may not be appropriate here.
- Rehabilitation facility: Z79 code becomes relevant on the next visit (office visit, readmission, etc.) as it reflects the “patient’s continuous use” of the medication.
General Rule:
- Don’t use Z79 for medications intended for short-term treatment of acute conditions.
- Don’t use Z79 for medications newly prescribed during an inpatient stay, even if intended for long-term use.
Exceptions:
- Use Z79 on subsequent visits (office, readmission, rehab) to reflect ongoing medication use.
- Use Z79 at hospital discharge if a prolonged stay involved medication complications and the medication is continued post-discharge.
Reasoning:
Z79 documents long-term medication use and potential side effects/interactions. It’s not relevant for newly initiated medications.
Allzone’s COPD Coding Services
Chronic Obstructive Pulmonary Disease coding involves assigning specific codes to diagnoses and procedures related to COPD. These codes are used for medical billing and ensure accurate reimbursement for healthcare providers.
There are two main types of codes used for COPD coding:
- ICD-10-CM Codes: These codes identify the specific type of Chronic Obstructive Pulmonary Disease a patient has. For example, J44.1 is the code for COPD with an acute exacerbation.
- CPT Codes: These codes describe the procedures performed on a Chronic Obstructive Pulmonary Disease patient. For example, 94640 is the code for an inhalation treatment for acute airway obstruction.
Here’s what COPD coding services we offer:
- Assigning accurate ICD-10-CM and CPT codes based on medical documentation.
- Ensuring code compliance with current healthcare regulations.
- Maximizing reimbursement by identifying all appropriate codes for billing.
- Improving coding efficiency through automation and experienced coders.
Benefits of using our coding services:
- Reduced risk of coding errors: Proper coding avoids claim denials and ensures timely payments.
- Improved cash flow: Accurate coding maximizes reimbursement for COPD services.
- Focus on patient care: Medical staff can dedicate more time to patients by outsourcing coding tasks.