Resolved COPD and emphysema in ICD-10

[RinshidaK_89540]

Original date posted: Jul 18, 2016

Question:
JoJuan
There is some confusion in my office with coding COPD w/emphysema in icd 10. Some coders agree that the correct coding of emphysema with COPD is J43.9 while others argue that when looking up in the index they get J44.9.

The confusion then comes when you look at J43.9 and there is an excludes 1 note stating that emphysema with chronic obstructive bronchitis should be coded to J44-. That is saying to me that if the provider doesn't document specifically chronic obstructive bronchitis then it is ok to pick up J43.9.

The modifiers in the index include the COPD with the J43.9 code Emphysema(chronic)(lung)(obstructive)(pulmonary).

I am siding with the J43.9 based on documentation of just COPD and emphysema if chronic obstructive bronchitis is documented then I would use J44.9. Is my reasoning wrong???

I just want to be sure that everyone is on the same page.

Answer Thread:
Alicia Scott
The first thing to remember is that emphysema is a type of COPD. It starts with a structural change in the anatomy. I believe the best code is J44.9 because J44 is Other COPD. It is specified so J43.9 is not really correct. Here is a great link for you to look at.
file:///C:/Users/Alicia/Downloads/ICD10_COPD.pdf

JoJuan

The first thing to remember is that emphysema is a type of COPD. It starts with a structural change in the anatomy. I believe the best code is J44.9 because J44 is Other COPD. It is specified so J43.9 is not really correct. Here is a great link for you to look at.
file:///C:/Users/Alicia/Downloads/ICD10_COPD.pdf

Hi Alice,
I'm trying to look at the link it won't let me download would you be able to send to my email or post the link again? JLJ1989@gmail.com

Thank you!!!

RACoder
I believe emphysema with COPD would be coded as J43.9. There is an Excludes 1 note under J44.9 for emphysema without chronic bronchitis (J43.-).

The following link I found from a health plan explains the rationale.
https://www.mvphealthcare.com/provi..._Care_Chapter10_DiseasesRespiratorySystem.pdf

 

[JamieN_9335]

I came across a video by Medical Coding Clarified, titled ICD-10-CM Coding: COPD Coding Explained.



She explains that if it is noted in the patient's record that the patient has COPD, and a pulmonary consultant who sees the patient during the hospitalization documents that the patient has emphysema, then only code J43.9 Emphysema, unspecified. The reason being is that the code represents the specific type of COPD.

 

[AnitaW_89599]

Your reasoning aligns with the latest guidelines. According to the updated ICD-10-CM coding guidelines, when both COPD and emphysema are documented, you should assign J43.9 (Emphysema, unspecified). This is because emphysema is considered a specific type of COPD.

The confusion arises from the Excludes 1 note, which has been updated to an Excludes 2 note, indicating that while these conditions are related, they are not mutually exclusive1. However, the guidance from the Coding Clinic clarifies that only the emphysema should be coded when both conditions are present.

So, if the provider documents only COPD and emphysema without specifying chronic obstructive bronchitis, J43.9 is the appropriate code. If chronic obstructive bronchitis is documented, then J44.9 should be used.

I hope this clears up the confusion! If you have any more questions or need further clarification, feel free to ask.