Chronic obstructive pulmonary disease, or COPD is a progressive lung disease, which gets worse over time. Approximately 1 in 17 American adults have COPD. So that is roughly 16 million Americans who are diagnosed with COPD, but millions more may have COPD and not know it. The documentation and medical coding of COPD can occur in both the outpatient and inpatient health settings. For hospitals and healthcare organizations across the country, ongoing auditing and education is vital to medical coding accuracy and for meeting compliance.
In patients with Chronic Obstructive Pulmonary Disease or commonly called “COPD,” there is an obstruction in the flow of air that disturbs the normal breathing pattern; it includes pathologies such as emphysema or chronic bronchitis, or both. COPD is the evolution of adverse functional changes associated with the airways. The condition of “Bronchitis” is an inflammation of the lining of the bronchial tubes, which carry air to and from the lungs. While “Emphysema” is a chronic lung disease caused by damage to the alveoli, the tiny air sacs within the lung where the exchange of oxygen and carbon dioxide takes place. Smoking, second-hand smoke and exposure to environmental particulates often as seen as causing of COPD.
The most common COPD symptoms include:
- Cough
- Shortness of breath
- Wheezing
- Chest tightness
There are stages of COPD which are based on the forced expiratory volume or FEV1. This is the maximal amount of air someone can forcefully exhale in one second. The lower the FEV1, the more severe the disease. Clinicians will access the expiratory volume and determine the treatment needed.
Treatment for COPD can include the following:
- Bronchodilators to open airways — Most come in the form of inhalers. Both short- and long-acting bronchodilators are available.
- Steroids — These reduce inflammation, swelling and mucus production. Less swelling allows more space through which air can travel. Steroids can be inhaled, taken orally or injected.
- Immunization — Centers for Disease Control and Prevention recommends that individuals with COPD get flu and pneumococcal vaccinations to help protect against complications of COPD.
- Oxygen therapy — Because COPD can lower blood oxygen levels, this treatment provides the body with the extra oxygen it needs. Home and portable oxygen can be used.
It is important to remember that we often see “Chronic Respiratory Failure” with COPD patients, who are on home oxygen. COPD patients can exacerbate and go into Acute Respiratory Failure quickly and need immediate medical attention and very often hospitalization.
Review of the health record documentation not only for the diagnosis itself to be documented but also for the clinical indicators and treatment plan of the patient to a major part of the coding and CDI (Clinical Documentation Integrity) professionals work. Many payers look closely at the clinical indicators and treatment during their record review process so being attentive to these elements during CDI and Medical Coding will aide in ensuring complete and accurate documentation and coding.
In ICD-10-CM Chapter 10, you will find the Respiratory System with code range J00-J99, this is where the codes for COPD are located. At the beginning of this Chapter in the tabular there are instructional notes to be followed. When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).
Use additional code, where applicable, to identify:
- Exposure to environmental tobacco smoke (Z77.22)
- Exposure to tobacco smoke in the perinatal period (P96.81)
- History of tobacco dependence (Z87.891)
- Occupational exposure to environmental tobacco smoke (Z57.31)
- Tobacco dependence (F17.-)
- Tobacco use (Z72.0)
There are three codes to capture COPD which are within the subcategory J44 Other Chronic Obstructive Pulmonary Disease:
- J44.0 Chronic obstructive pulmonary disease with lower respiratory infection (CC, HCC)
- J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation (CC, HCC)
- J44.9 Chronic obstructive pulmonary disease, unspecified (HCC)
As indicated above, COPD can impact the reimbursement as the diagnosis is a complication/comorbidity (CC) or hierarchical condition category (HCC). In the acute care inpatient hospital MS-DRGs: Principal diagnosis code J44.9 COPD, unspecified (without a surgical procedure), will group to any of the following three MS-DRGs (ver. 37.0):
- 190 Chronic obstructive pulmonary disease with MCC
- 191 Chronic obstructive pulmonary disease with CC
- 192 Chronic obstructive pulmonary disease without CC/MCC
It’s important for Inpatient coding and Clinical Documentation Integrity staff to know that for reporting purposes, the definition for “other diagnoses” is interpreted as additional conditions that affect patient care in terms of requiring:
- Clinical evaluation;
- or therapeutic treatment;
- or diagnostic procedures;
- or extended length of hospital stay;
- or increased nursing care and/or monitoring.
COPD can be a primary or principal diagnosis, or it can be “other diagnosis” or secondary diagnosis for an encounter. Check closely the circumstances of the encounter in determining the correct code assignment. MRA has a March webinar available regarding the clinical documentation and medical coding aspects surrounding COPD and Respiratory Failure which you can access free here.
Discuss the documentation and coding of COPD and identify any issues or problems that block achieving complete and accurate diagnostic reporting. Always audit and provide education as a best practice also.
References:
IICD-10-CM Guidelines FY 2023 (cms.gov); Q&A: Respiratory documentation FAQs | ACDIS
