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Outpatient Facility Coding Alert

Reader Question:

Report Single Code for COPD, Bronchiectasis Dx Combo

Question: What is the ICD-10-CM code to report for chronic obstructive pulmonary disease (COPD) with bronchiectasis?

Colorado Subscriber

Answer: When documented as individual diagnoses from the same encounter, you would code COPD as J44.9 (Chronic obstructive pulmonary disease, unspecified) and bronchiectasis as J47.9 (Bronchiectasis NOS). However, as long as you take the appropriate steps in finding each respective code in the tabular, you’ll see that you should only be reporting one final diagnosis code.

That becomes clear when you have a look at code J44.9 in the ICD-10-CM tabular. While there are no specific notes listed under J44.9, you’ll see six diagnoses listed under the Excludes1 note for category code J44. The first note listed is “bronchiectasis (J47.-).” This means that you cannot report J44.9 with J47.9 in any instance.

Your initial instinct may be to report J44.9 since the Excludes1 note appears under category code J44; however, this would be a false assumption. Thanks to a recent AHA Coding Clinic (2018 Q4), you now know that you should actually report the code listed within the Excludes1 note, not the category code that includes the Excludes1 note.

This means that this patient encounter warrants that you report J47.9 exclusively. However, keep an eye on the “Use additional” notes underneath category code J47. These notes instruct you to report additional circumstantial codes such as tobacco dependence and history of tobacco dependence.