Coding Clarification: Respiratory Conditions

Coding Respiratory conditions has created much confusion in the coding industry since the recent October 1^st update that changed many of the excludes 1 to excludes 2.  One example of this is that prior to October 1^st, if the chart listed both emphysema and COPD, you were instructed to code the emphysema because there is an excludes 1 note that means you cannot code both of those codes on the same claim. 

The ICD-10-CM Coding Guidelines for FY 2024 explains excludes notes as follows:

The ICD-10-CM has two types of excludes notes. Each type of note has a different definition for use, but they are all similar in that they indicate that codes excluded from each other are independent of each other. A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider. A type 2 Excludes note represents “Not included here.” An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.

With the October 1^st update, many codes classified as respiratory conditions that included excludes 1 notes have now been updated to excludes 2. It is now appropriate and acceptable to code COPD, Emphysema, and Bronchiectasis on the same claim.

The update also created a new code to further expand chronic obstructive pulmonary disease.  J44.89 Other specified chronic obstructive pulmonary disease.

This code should be used when the documentation indicates chronic asthmatic (obstructive) bronchitis or chronic emphysematous bronchitis rather than the unspecified J44.9 Chronic obstructive pulmonary disease. 

J44.89 does not need to be over applied, however.  If a patient with a lung disease falling into that ICD-10 code has an exacerbation, it is still appropriate to use J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation instead of the J44.89.

Contact us for questions on how to code these respiratory scenarios!

Reference:  https://www.cms.gov/files/document/fy-2024-icd-10-cm-coding-guidelines.pdf