A patient with emphysema presents due to COPD and pneumonia. Per Coding Clinic Fourth Quarter 2017, COPD in a patient with emphysema is reported with code J43.9, Emphysema, unspecified. However, there is an Excludes1 note found at category J44, Other chronic obstructive pulmonary disease, which prohibits the reporting of code J44.0, Chronic obstructive pulmonary disease with acute lower respiratory infection, with code J43.9. Should we report an additional code to capture the pneumonia along with code J43.9? Or should code J44.0 be reported to capture the COPD with pneumonia? What is the appropriate code assignment for COPD and pneumonia in a patient with emphysema?
Assign codes J43.9, Emphysema, unspecified, and J18.9, Pneumonia, unspecified organism. 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.