COPD with asthma

The comparison between ICD-10-CM Chapter 10 and ICD-9-CM reveals a removal of several paragraphs for Chronic Obstructive Pulmonary Disease (COPD) with Asthma. In ICD-9-CM there were six specific guidelines to review; however, in ICD-10-CM there is one paragraph to sum up the proper coding of these conditions.

"The codes in categories J44-J45 distinguish between uncomplicated cases and those in acute exacerbation. An acute exacerbation is a worsening or a decompensation of a chronic condition. An acute exacerbation is not equivalent to an infection superimposed on a chronic condition, though an exacerbation may be triggered by an infection."

The terminology used to describe asthma has also been updated to reflect the current clinical classification of asthma. There are now terms such as mild intermittent, mild persistent, moderate persistent, and severe persistent. From a clinical standpoint, the term intermittent refers to less than or equal to two times per week; mild persistent is more than two times per week; moderate persistent occurs daily and may restrict physical activity; and severe persistent occurs throughout the day with frequent severe attacks limiting the ability to breath.

Expansion of Chapter 10 codes

Some of the codes in Chapter 10 have been expanded to include notes that indicate an additional code should be assigned or an associated condition should be sequenced first.  This is why it is most important to not code directly from the index. As always, first reference the index and then confirm the code and any additional user notes in the tabular portion of the book.

Codes moved to Chapter 10

Certain codes have moved to Chapter 10 from other locations with streptococcal sore throat being an example. A new section (Section I.C.10.d) that specifically addresses proper coding for ventilator associated pneumonia is now included in Chapter 10, whereas in ICD-9-CM this topic was addressed in Chapter 17 (Injury and Poisoning).

Be sure to read these guidelines in their entirety prior to assigning any ICD-10-CM codes.

References:
ICD-10-CM Official Guideless for Coding and Reporting 2016
https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2016-ICD-10-CM-Guidelines.pdf (PDF, 1.40 MB)

Author - Female

About the author

Amy Chapman, CPC, CPMA is an AHIMA Approved ICD-10-CM Trainer.