q: i need help in understanding how to codethe following: these are three diagnoses â€“ the way i took this question. three diagnoseson one encounter, one patient. the three are: 1. acute exacerbation of copd or chronic obstructivepulmonary disease. 2. acute bacterial exacerbation of chronicbronchitis. 3. asthma with exacerbation. our coder is stating: â€œi would code thisas 493.22 onlyâ€ which is chronic obstructive asthma with acute exacerbation. she or he,the coder is stating that, â€œthe coworkers would code this with 491.22 and 493.22. idonâ€™t understand how you can get acute bronchitis out of exacerbation of chronic bronchitis.any help would be greatly appreciated.â€
a: this can be very confusing â€“ the acuteand the chronic â€“ especially when you got a disease process that is so similar. whati did was i took the two codes and just put them up here. so,493.22 states, â€œchronic obstructive asthma; with (acute) exacerbation.â€ thatâ€™s a specificcode. you can have chronic obstructive asthma without the acute exacerbation. then, we have491.22, â€œobstructive chronic bronchitis; with acute bronchitis. the point that i think that will help thecoder that is asking this, is understanding a little bit about the disease process. firstof all, you might wonder, â€œwell, how come weâ€™re not coding copd, because that wasthe first thing listed?â€ actually, when
you have these other two diagnoses, if younote down whereâ€¦ this is what you get when you look up â€“ copd 496. down here on thebottom it states, â€œnote: this code is not to be used with any code from categories 491-493.â€and both of those other codes are in that range, so weâ€™re not going to code the copd.we are going to code just for the asthma and the bronchitis. the question was: â€œhow come weâ€™re codingfor both of those? how are we getting an acute out of a chronic condition?â€ a: the fact is itâ€™s very common. a chroniccondition means that it just doesnâ€™t go away. we always have it.
iâ€™ll use myself as an example for this,because this is really is right up my alley. i've had asthma since i was child. asthmais actually condition in which the airways, they narrow and then they swell. then, whathappens is your body starts producing extra mucus and phlegm because of the irritationand then you're airway is just constricted. i would like to say â€“ at a lower level downin your lungs. bronchitis is a little different. bronchitisis actually an inflammation. that doesnâ€™t mean you donâ€™t get inflammation with theasthma, but itâ€™s not the same disease actually here. asthma is swelling and anything canset off that swelling. it could be an allergy. it could be having an anxiety attack.
it could be getting choked on something whichhappens to me. it could be walking too far or running and all of a sudden everythingstarts swelling up, because itâ€™s a condition that you have. unlike bronchitis where something has to irritatethe bronchial passages to make them swell and start producing mucus but they're inflamed,thus the â€œitis" at the end of bronchitis. now, bronchitis affects the bronchial passages.i just happen to have bronchial asthma. you can have asthma down inside the lungs or youcan have it actually in different parts of the lung, but minecommonly hits the bronchial passages, so i have bronchial asthma.
it is actually two separate conditions andmy asthma is chronic. do i get a flare up once in a while? yes, and that would be classifiedas an acute exacerbation. this happens often for me in the springtime just like everybodyelse when all the pollen starts to fall. unlike most people that have just an allergy attack,iwill have an asthma attack which means itâ€™s not an inflammation. it just means that thosepassages close up and then because they start to close they produce mucus. if you get bronchitis, you either got a virusor bacteria has gotten in there and then you have aninflammation â€“ two separate diseases, so therefore you need two separate codes. canyou have
one without the other? yes. can you have themboth at the same time? absolutely. i'm a living proof of that, because my asthma goes intomy bronchial passages and then it gets irritated andthen it gets infected because itâ€™s raw and irritated and then you get bronchitis. yes, you do code both and yes you can havea chronic condition thatâ€™s there. i have all these little inhalers that i keep withme all the time that my doctor tells me and i have to use all the time.thatâ€™s to keepthe passages open. so, i live with that, but if it gets irritated, thus â€œitis" then itâ€™sa different condition. can i have an exacerbation? absolutely, at any moment. something couldtrip it off and i could have one right now
in front of you. how exciting, but i won'tdo that for you for the webinar. it would freak boyd and laureen out. thatâ€™s why youhave the separate codes. very exciting, isnâ€™t it? thatâ€™s it guys.