Cough. Wheeze. Now how do we code that respiratory problem?

There is always so much confusion on respiratory codes … here is a quick guide on when to use them.

496, COPD NEC

This umbrella term means there are no exacerbations or contributing diseases.

491.20: Obstructive chronic bronchitis/COPD without exacerbation

Do NOT use this code with COPD without exacerbation UNLESS there is documentation that says “chronic bronchitis” or some other clear documentation.

491.21: Obstructive Chronic Bronchitis/COPD with exacerbation

This deals with COPD and emphysema that have acute exacerbation or are listed as decompensated.

491.22: Obstructive Chronic Bronchitis/COPD

This isn’t used often, but it is for acute bronchitis along with chronic bronchitis, including a case that has emphysema with the bronchitis.

492.8: Emphysema/COPD

Obstructive emphysema. This can also be used for NOS emphysema.

493.2x: Chronic Obstructive Asthma

This set of codes deals with chronic problems with asthma and COPD. Don’t forget the 5th digits to indicate acute exacerbation, as appropriate. This one also includes obstructive chronic bronchitis.

Chapter 7 codes involve a lot of combination coding. Make sure that you’re using both the Alphabetical Index and the Tabular List to find the right code.

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