What is COPD?

What is COPD?

Chronic Obstructive Pulmonary Disease or COPD is the 3rd leading cause of death in the U.S. So, what exactly is COPD? COPD is a respiratory condition where there is chronic obstruction of airflow in the lungs. Air is breathed into the lungs but a patient with COPD has trouble emptying air out of the lungs. This inability to exhale can cause patients with COPD to have CO2 retention. COPD is an irreversible and progressive disease in which lung function worsens over time. Once the disease becomes symptomatic, progression may be fast and relentless depending on the treatment that the patient agrees to, and the lifestyle changes made. Once a patient is diagnosed with COPD this condition would be coded (when documented) for the rest of the patient’s life since there is no current cure for this disease . There are treatments for COPD that help slow progression, but they do not cure the disease.

Emphysema and chronic obstructive bronchitis are specific types of COPD. Chronic obstructive bronchitis involves increased mucous production and swelling in the airway. When this occurs, air passageways become constricted, and it is difficult for the patient to take a good breath. Emphysema involves damage to the inner walls of the alveoli in the lungs. Damaged inner walls rupture, creating large air spaces rather than many small ones. This reduces the surface area in the lung through which air exchange can take place., When alveoli don’t work properly old air gets trapped inside, leaving no room for new, oxygenated air to enter. Since the term COPD is nonspecific and represents any form of chronic obstructive lung disease, an additional code for unspecified COPD is not needed when the diagnosis of emphysema is documented in the healthcare record. Emphysema is a specific type of COPD, so only the code for the more specific diagnosis (emphysema) is assigned. Chronic obstructive asthma is another specific type of COPD.

Symptoms of COPD:

• Shortness of breath (nonexertional)
• Persistent/chronic coughing
• Increased sputum/mucous production
• Wheezing and a tight feeling in the chest
• Increased work of breathing
• Headache due to hypoxia/hypercapnia
• Hyperinflation of the lungs (barrel chest)

Causes of COPD:

• Smoking (75% of people with COPD smoke or have smoked)
• Secondhand smoke
• Genetics (alpha-1 antitrypsin deficiency)
• Heavy exposure to chemicals or dust
• Indoor and outdoor pollution

Treatment for COPD:

• If you smoke…STOP
• Inhaled medication; bronchodilators/corticosteroids
• Antibiotics to treat exacerbation caused by respiratory infection
• Immunization against influenza, pneumonia, COVID-19 and respiratory syncytial virus (RSV)
• Supplemental oxygen
• Lung volume reduction surgery
• Lung transplantation
• Pulmonary rehabilitation
• Support groups

Compliance with prescribed medication, preventive action and lifestyle management are key to controlling symptoms and avoiding exacerbations.

Coding Examples:

• A patient’s documented diagnoses include COPD and emphysema. Should two codes be assigned? No. Emphysema is a specific type of COPD, so only the code for the more specific condition is assigned. Per the ICD-10-CM Alphabetic Index, only J43.9 Emphysema, unspecified is reported.
• A patient’s documented diagnoses include COPD and chronic bronchitis. As with emphysema, chronic obstructive bronchitis is a specific type of COPD. In this case, only code J44.89 Other specified chronic obstructive pulmonary disease, is reported as directed by the ICD-10-CM Alphabetic Index.
• A patient is admitted with acute bronchitis and has a history of COPD. Does this mean that the COPD is automatically considered to be exacerbated? 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 exacerbated, 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/PCS Coding Clinic, First Quarter 2023 Pages: 34-35
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 2017 Page: 96-98
ICD-9-CM Coding Clinic, Fourth Quarter 1993 Page: 26
ICD-9-CM Coding Clinic, Second Quarter 1992 Page: 16 to 17

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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.