View ICD 9-cm codes for COPD Exacerbation, Asthma, Bronchitis, Emphysema. Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases.

Chronic obstructive pulmonary disease is a chronic bronchitis alpha-1 antitrypsin deficiency that is a genetic form of emphysema. The disease is most of the time characterized by the narrowing or obstruction of airflow and interference that hinders normal breathing. The primary risk factor for chronic obstructive pulmonary disease is smoking or second hand smoking, heredity and air pollution.

COPD ICD 9CM Codes: Exacerbation, Asthma, Bronchitis, Emphysema

COPD with Acute Bronchitis ICD 9CM Codes

A diagnosis of COPD and acute bronchitis is classified to code 491.22. It is not necessary to assign code 466.0 (acute bronchitis) with 491.22. Code 491.22 is also assigned if the physician documents acute bronchitis with COPD exacerbation. However, if acute bronchitis is not mentioned with the COPD exacerbation, then code 491.21 is assigned (AHA Coding Clinic for ICD-9-CM, 2008, fourth quarter, pages 241-244).

ICD 9CM Code for COPD with Asthma

Asthma with COPD is classified to code 493.2x. However, all coding directives in the Tabular List and index need to be reviewed to ensure appropriate code assignment. A fifth-digit sub classification is needed to identify the presence of status asthmaticus or exacerbation.

COPD with Exacerbation

Exacerbation is defined as a decompensation of a chronic condition. It is also defined as an increased severity of asthma symptoms, such as wheezing and shortness of breath. Although an infection can trigger it, an exacerbation is not the same as an infection superimposed on a chronic condition. Status asthmaticus is a continuous obstructive asthmatic state unrelieved after initial therapy measures.

If a physician documents both exacerbation and status asthmaticus on the same record, only assign the fifth digit "1" to show the status asthmaticus. Sequence the status asthmaticus code first if documented with any type of COPD or with acute bronchitis (AHA Coding Clinic for ICD-9-CM, 2008, fourth quarter, pages 241-244).

COPD with exacerbation is classified to code 491.21, which also includes the following:
  • Acute Exacerbation of COPD
  • Exacerbation of COPD
  • Decompensated COPD
  • Decompensated COPD with Exacerbation
  • COPD in Exacerbation
  • Severe COPD in exacerbation
  • End-stage COPD in exacerbation
The word Acute need not be documented to assign code 491.21 for exacerbation of COPD (AHA Coding Clinic for ICD-9-CM, 2002, third quarter, page 18).

When the acute exacerbation of COPD is clearly identified, it is the condition that will be designated as the principal diagnosis. (AHA Coding Clinic for ICD-9-CM, 1988, third quarter, pages 5-6).

According to current coding advice, acute exacerbation of COPD, acute bronchitis, and acute exacerbation of asthma is classified to codes 491.22 and 493.22 (AHA Coding Clinic for ICD-9-CM, 2006, third quarter, page 20).

Coding and sequencing for COPD are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care.

COPD Diagnosis and Treatment

After diagnosis, the most important and effective treatment for COPD is smoking cessation. The benefits of quitting smoking apply regardless of age, amount smoked, or severity of COPD.

In addition to medications, patients may require home oxygen, pulmonary rehab to improve overall quality of life and, in severe cases, surgery such as a lung transplant or lung volume reduction, during which the physician removes small wedges of damaged tissue.

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