10 Oct Off
By Debra L. Byble, CPC, CRC
When ICD-10-CM was implemented, it was no longer necessary to code for the difference between extrinsic or intrinsic asthma. Found in section J45 of ICD-10-CM, asthma now requires documentation of mild, medium, and severe asthma. Further documentation is needed to assign the correct code between the differences of intermittent, and persistent. The greater specificity of ICD-10-CM requires another level of detail: uncomplicated, (acute) exacerbation, and status asthmaticus.
Below are some samples of how the codes appear in the ICD-10-CM book:
• J45 Asthma
• J45.2 Mild intermittent asthma
• J45.20 Mild intermittent asthma, uncomplicated
• J45.21 Mild intermittent asthma with (acute) exacerbation
• J45.22 Mild intermittent asthma with status asthmaticus
• J45.3 Mild persistent asthma
• J45.30 Mild persistent asthma, uncomplicated
• J45.31 Mild persistent asthma with (acute) exacerbation
• J45.32 Mild persistent asthma with status asthmaticus
Asthma can sometimes co-exist with COPD. When a provider documents COPD with asthma, but does not specify the asthma type, the coder must assign ONLY the J44.9 for COPD. There is an instructional note in the ICD-10-CM tabular list that tells the coder to “use additional code for type of asthma, if applicable”, but the provider must document the specific type for the coder to assign an additional code. There are four acceptable types:
• Mild intermittent asthma
• Mild persistent asthma
• Moderate persistent asthma
• Severe persistent asthma
This should clarify the need to be specific when documenting for asthma and the importance of describing to the highest level of specificity. Always remember to state whether the asthma is intermittent or persistent, as this is crucial to the codes chosen in ICD-10.
Finally, a long-standing diagnosis of persistent asthma in an elderly patient should prompt a provider to consider whether the actual condition is better termed as chronic obstructive asthma or COPD, especially if treatment is consistent with COPD therapy.