A patient with emphysema and chronic obstructive pulmonary disease (COPD) is admitted for treatment of acute bronchitis and COPD. There is no mention of chronic bronchitis. ICD-10-CM’s Index refers to code J44.0, Chronic obstructive pulmonary disease with acute lower respiratory infection, when referencing acute bronchitis with COPD. The Excludes1 note found at category J44 prohibits assigning code J44.0 with code J43.9. How is COPD due to acute bronchitis in a patient with emphysema coded?
Assign codes J43.9, Emphysema, unspecified, and J20.9, Acute bronchitis, unspecified. Since emphysema is a form of COPD, it is not appropriate to assign a code for “unspecified” COPD in addition to code J43.9. The advice previously published in Coding Clinic regarding COPD and emphysema was based on the current structure of the classification. Currently codes J43.9 and J44.0 cannot be assigned together because of the Excludes1 note. The Centers for Disease Control and Prevention/National Center for Health Statistics, the organization responsible for revisions to ICD-10-CM, is aware of this issue and has agreed to consider a Coordination and Maintenance proposal for possible revisions to the instructional note.