Coding Tip: What is COPD?
Kim Carrier RHIT, CDIP, CCS, CCS-P
Director of Coding Quality Assurance
AHIMA Approved ICD-10-CM/PCS Trainer
November is COPD Awareness Month. Chronic obstructive pulmonary disease is commonly referred to as COPD by patients and physicians. Let’s look at what COPD is and what causes this disease.
What is COPD?
COPD is a respiratory condition where there is chronic obstruction to airflow in the lungs. Air is breathed into the lungs but a patient with COPD has trouble emptying air out of the lungs. This can also cause patients with COPD to have CO2 retention. COPD is an irreversible and progressive disease in which the lung function worsens as time goes on. Once the disease becomes symptomatic the progression may be fast and relentless depending on the treatment that the patient agrees to and the lifestyle changes made. Once the diagnosis of COPD is given to a patient this would be coded (when documented) for the rest of the patient’s life since there is no cure for this disease at this time. There are treatments for COPD that help in progression but they do not cure the disease. COPD is the 3rd leading cause of death in the U.S.
Emphysema and chronic bronchitis are specified types of COPD. Chronic bronchitis is when there is increased mucous and swelling production in the airway. When this occurs the breathing tubes become smaller than normal and it is difficult for the patient to get or take a good breath. Emphysema involves damage to the walls of the alveoli of the lung. When the walls are damaged the alveoli lose their ability to stretch and spring and the air gets trapped. Since the term COPD is unspecified and represents any form of unspecified chronic obstructive lung disease, an additional code is not needed when the diagnosis of emphysema is documented in the healthcare record. The emphysema is the specified type of COPD. Asthma is not included in the definition of COPD but it is not uncommon for patients with COPD to also have asthma.
Symptoms of COPD:
- Shortness of breath
- Persistent coughing/chronic coughing
- Increased sputum/mucous production
- Wheezing and a tight feeling in the chest
Causes of COPD:
- Smoking (75% of people with COPD smoke or have smoked)
- Second hand smoke
- Genetics (alpha-1 antitrypsin deficiency)
- Heavy exposure to chemicals or dust
- Indoor and outdoor pollution
Treatment for COPD:
- If you smoke…STOP
- Bronchodilators given by your physician
- Anti-inflammatory drugs (steroids) given by your physician
- Antibiotics to treat exacerbations
- Oxygen when the oxygen in the blood is low
- Lung volume reduction surgery
- Lung transplantation
- Pulmonary rehabilitation
- Support groups
In order to properly treat COPD and control some of the symptoms and reduce the exacerbations, the patient must be compliant with their medications. These must be taken daily or however often prescribed. Each patient is different in their needs. The medications will be needed for life.
Coding Examples:
- A patient is documented in the record to have COPD and emphysema throughout. Should both diagnoses be coded? No. Per the ICD-10-CM Alphabetic Index, only J43.9-Unspecified emphysema is reported. Remember emphysema is a specific type of COPD.
- A patient is documented in the record to have COPD and also has a diagnosis of chronic bronchitis and is on long term medications to help keep the chronic bronchitis from exacerbations. In this case, only code J44.9- Chronic obstructive pulmonary disease, unspecified is reported following the ICD-10-CM Alphabetic Index.
- A patient is admitted with acute bronchitis and also has a history of COPD. Does this mean that the COPD is automatically considered to be in exacerbation? No. Should both diagnoses be coded? Yes. In this case, J44.0-Chronic obstructive pulmonary disease with acute lower respiratory infection and J20.9- Acute bronchitis, unspecified would be reported. If the record further specified that the COPD was in exacerbation, then a third code would also be reported to fully describe and report the diagnoses documented – J44.1-Chronic obstructive pulmonary disease with (acute) exacerbation.
If you need help to quit smoking, please call the National Cancer Institute’s Smoking Quitline for support at 1-877-44U-QUIT.
References
patch.com/massachusetts/charlestown/november-copd-awareness-month
nhlbi.nih.gov/health-topics/copd
medlineplus.gov/copd.html
thoracic.org/patients/patient-resources/resources/copd-intro.pdf
cdc.gov/copd/index.html
ICD-10-CM Official Guidelines for Coding and Reporting FY 2019 Page 52
ICD-9-CM Coding Clinic, July-August 1984 Page: 17 to 19
ICD-9-CM Coding Clinic, Third Quarter 1988 Page: 5 to 6
ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD-10 2017 Page: 97
ICD-9-CM Coding Clinic, Fourth Quarter 1993 Page: 26
ICD-9-CM Coding Clinic, Second Quarter 1992 Page: 16 to 17
Happy Coding!
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
Popular Posts
Query Tip: Writing a Query Question – Simple and Concise is the Key
The question asked in a physician query may be the most important element of the document. Query questions need to be as simple and concise as possible. The physician should have no doubt what the coder is asking.
Coding Tip: Coding Complications of Transplanted Organs
Coding complications of transplanted organs has always been a coding dilemma. With the implementation of ICD-10-CM that didn’t change. However, coders have multiple directives to help in determining what a complication of the transplant is vs. non-transplant conditions and diseases.
Find Your Routine: Take Advantage of Educational Opportunities
We interviewed our most productive coders, reviewers and members of our education team, asking them what steps they take to find a rhythm that works for them. This week, we talked with Beth Martilik, MA, RHIA, CDIP, CCS, Assistant Director of Education, about the steps she takes to find her routine.
Coding Tip: Atrial Fibrillation
With the implementation of ICD-10-CM came more codes for reporting many different conditions and diseases, and atrial fibrillation is one of those. For many years there was only one code available for reporting this condition, even when the physician further specified the type of atrial fibrillation that the patient had. In ICD-10-CM, there are four codes to report atrial fibrillation.
Coder Q&A with Pat Macc: Mucoid Casts and Mucus Plugs
We have a case where the physician removes mucoid casts found during bronchoscopy. We have also seen mucus plugs removed during bronchoscopy. The MD performs bronchial washings then removes a large amount of tenacious and thick mucoid casts via bronchoscopy. Is this coded drainage, extirpation or excision? What body part is used?
Subscribe to our weekly newsletter
Latest News
Query Tip: Writing a Query Question – Simple and Concise is the Key
The question asked in a physician query may be the most important element of the document. Query questions need to be as simple and concise as possible. The physician should have no doubt what the coder is asking.
Coding Tip: Coding Complications of Transplanted Organs
Coding complications of transplanted organs has always been a coding dilemma. With the implementation of ICD-10-CM that didn’t change. However, coders have multiple directives to help in determining what a complication of the transplant is vs. non-transplant conditions and diseases.
Find Your Routine: Take Advantage of Educational Opportunities
We interviewed our most productive coders, reviewers and members of our education team, asking them what steps they take to find a rhythm that works for them. This week, we talked with Beth Martilik, MA, RHIA, CDIP, CCS, Assistant Director of Education, about the steps she takes to find her routine.
Coding Tip: Atrial Fibrillation
With the implementation of ICD-10-CM came more codes for reporting many different conditions and diseases, and atrial fibrillation is one of those. For many years there was only one code available for reporting this condition, even when the physician further specified the type of atrial fibrillation that the patient had. In ICD-10-CM, there are four codes to report atrial fibrillation.
Coder Q&A with Pat Macc: Mucoid Casts and Mucus Plugs
We have a case where the physician removes mucoid casts found during bronchoscopy. We have also seen mucus plugs removed during bronchoscopy. The MD performs bronchial washings then removes a large amount of tenacious and thick mucoid casts via bronchoscopy. Is this coded drainage, extirpation or excision? What body part is used?
Query Tip: How to Be More Efficient
The key to making the query process more efficient is to look for words or documentation while reviewing the record that may signal a potential query opportunity and to note the finding at that time. By the time a coder reaches the end of a record, documentation may have been found to eliminate the need for the query.
Coder Q&A with Pat Macc: Metastatic Cancer
Question: This patient is noted to have “Lymphangitic carcinomatosis of lungs with mediastinal lymph nodes.” How would I code the diagnosis? Would I code metastatic cancer to the lung (C78.01) or metastatic cancer to the lymph nodes (C77.1)?
Coding Tip: Root Operation Selection Excision vs. Resection
Coding these can be challenging for coders when trying to decipher the operative notes and terms that are used. The physicians are still using the terms excision and resection interchangeably and review of the entire operative note is required to select the appropriate root operation. Remember, it is the coder’s responsibility to determine the root operation based on the details from the physician in the operative report.
Coder Q&A with Pat Macc: Collapse of an Endograft
This would be considered a “mechanical” complication of the stent graft since the MD states it is a fracture of the endograft and it is folded over on itself. I would change T82.898A TO T82.598A for Other mechanical complication of other cardiac and vascular devices and implants, initial encounter. I did not use “displacement” because the surgeon did not state that the graft was displaced, only that it collapsed upon itself causing obstruction.
Find Your Routine: Be Flexible, Not Frustrated
We interviewed our most productive coders and reviewers, asking them what steps they take to find a rhythm that works for them. This week, we talked with Valerie Abney, CDIP, RHIT, CCS, about the steps she takes to find her routine.
Coding Tip: Periprosthetic Fracture Reporting and Sequencing
Osteoporosis alone is responsible for over a million fractures every year. Stress fractures are not as common but they do occur. There are more than 1 million total joint replacements in the U.S. each year, so there was a need to create codes for injuries that occur around or near the prosthesis. These are called “periprosthetic” fractures.
OIG Takes Notice of Coding Errors
Back in April, the Office of the Inspector General (OIG) published a report detailing its findings from a review of two groups of high-risk diagnosis codes, acute stroke and major depressive disorder. The objective was to determine whether selected diagnosis codes submitted to the Centers for Medicare and Medicaid Services for use in CMS’s risk adjustment program complied with Federal requirements.
Coder Q&A with Pat Macc: Coding for Newborn
There seems to be differences of opinions on the issue of a 40w0day gestation Can you clarify if P08.21 should be assigned for 40w0day infant or if it would not be assigned unless the infant’s gestation age was 40w1day or greater?
Query Tip: When to Query for Sepsis
Coders may find situations where a patient is documented as meeting SIRS or sepsis criteria, or has some clinical indicators reflective of possible sepsis, but the physician never documents sepsis as a diagnosis. Should the coder always query for sepsis in these instances?
Coder Q&A with Pat Macc: Principal Dx Selection
In this example, would it be appropriate to code the complication code T82.03XA, Leakage of heart valve prosthesis, initial encounter as the principal diagnosis over the HFpEF (heart failure exacerbation) code?
Find Your Routine: Track Trends to Save Time
We interviewed our most productive coders and reviewers, asking them what steps they take to find a rhythm that works for them. This week, we talked with Kerry Atkins, CDIP, CCS‑P, COC, CPC, CPCO, CPMA, CEMC, COBGC, RMB, Physician Services Consultant at HIA, about the steps she takes to find her routine.
Keeping a Healthy CMI
A higher CMI corresponds to increased consumption of resources and increased cost of patient care, resulting in increased reimbursement to the facility from government and private payers, like CMS. We know that documentation directly impacts coding.
Coding Tip: Spinal Procedures Reported in Addition to the Fusion
With the implementation of ICD-10-PCS more codes were developed in order to accurately report procedures. Spinal fusion coding is still a problematic coding issue and at times, even a coder’s nightmare. Coders often report only the code for the fusion thinking that one code would include all of the other procedures that are performed.
Coder Q&A with Pat Macc: Procedure Coding for a Breast Procedure
Answer: I would code 0HPT0NZ for removal of tissue expander from right breast, open and change 0HPT0JZ, removal of synthetic substitute from right breast, open, for removal of the acellular dermal matrix to 0HPT0KZ, Removal of nonautologous tissue substitute from right breast, open approach.
Coding Tip: “Code First” Instructional Notes in ICD-10-CM
There are certain conditions that have instructional notes in the ICD-10-CM tabular/coding conventions that guide the coder in sequencing. This is especially true when the condition has a common manifestation or underlying conditions of a chronic disease. If there is a “code first” note in the tabular, the coder should follow this instruction and sequence the underlying etiology or chronic condition first followed by the manifestation as an additional diagnosis.
Find Your Routine: Tools to Tackle Unpredictable Days
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and reviewers and asked them what steps they take to find a rhythm that works for them. This week, we talked with Meghan Schumacher, CPC, CPMA, Provider Coding Consultant at Health Information Associates, Inc., about the steps she takes to find her routine.
Time is Money
Last year, the Office of Inspector General (OIG) performed an investigation that found, “between 2014 and 2016, Medicare Advantage organizations overturned 75% of their preauthorization and payment denials upon appeal,” which is why, at HIA, we always advise our clients to engage in the appeals process.
Query Tip: Query for Acute Kidney Injury (AKI)
There may be instances where a coder will suspect the patient has acute kidney injury (AKI), but the physician has failed to document the diagnosis. In another scenario, the physician may have made the diagnosis, but there is a question of clinical validity. In either case, a query would be justified.
It Only Takes One Code
How many times have you heard “it only takes one code to get the claim paid”? With the emphasis on the severity of illness and the move toward value-based reimbursement in today’s healthcare climate, it is more important than ever for coders to report all applicable diagnoses. There are three important pieces: what the provider documents, how to the coder interprets that documentation and codes it, and then how it is extrapolated.
How to Reduce Claims Denials
The reimbursement landscape is already a complicated one – and the highly-complex claims denials process only adds fuel to the fire. A denied claim is one that has been determined by a payor to be in appropriate. Once a coding specialist amends the errors on a rejected claim, they can resubmit it for consideration. The time-intensive process has a significant impact on the cash flow for any setting in the healthcare environment. They are also very costly to appeal.
Query Tip: Query for Clinical Validation
When a practitioner documents a diagnosis that does not appear to be supported by the clinical indicators in the health record, a coder has four choices: (1) Code the diagnosis; (2) Ignore the diagnosis; (3) Generate a query to confirm clinical validation of a diagnosis; (4) Follow the facility’s escalation policy for clinical validation.
$30M Settlement for Medicare Advantage Upcoding
A California-based healthcare services provider and several of its affiliates have agreed to pay $30 million to resolve allegations they submitted inaccurate information about the health status of beneficiaries enrolled in Medicare Advantage Plans, according to the Department of Justice.
National Volunteer Week with HIA
Happy National Volunteer Week! This week we celebrate the impact volunteer work has on building stronger communities. We know that our staff have a positive impact while they’re on the job, and we are proud to share a few ways our #PeopleBehindTheNumbers are taking time to volunteer in their own local communities.
Challenges Facing ASCs in 2019
Scrutiny of coding compliance in the growing ambulatory surgical center (ASC) market has increased in recent years from both Medicare and private payers. This will only increase as the Centers for Medicare and Medicaid Services (CMS) moves towards value-based care.