By Judy Monestime bio
ICD-10-CM Chapter 10, “Diseases of the Respiratory System (J00–J99),” identifies codes for a wide variety of pulmonary conditions, ranging from acute upper respiratory infections, pneumonia, influenza, asthma, as well as diseases of the lower respiratory tract including chronic lung diseases and diseases acquired from exposure to external substances. Intraoperative and postprocedural complications are also available to be coded in this chapter.
The chapter includes the following sections:
- J00–J06, Acute upper respiratory infections
- J10–J18, Influenza and pneumonia
- J20–J22, Other acute lower respiratory infections
- J30–J39, Other diseases of upper respiratory infections
- J40–J47, Chronic lower respiratory diseases
- J60–J70, Lung diseases due to external agents
- J80–J84, Other respiratory diseases principally affecting the interstitium
- J85–J86, Suppurative and necrotic conditions of the lower respiratory tract
- J90–J94, Other diseases of the pleura
- J95, Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified
- J96–J99, Other diseases of the respiratory system
At the beginning of Chapter 10, the following instructional guideline appears that instructs the professional to use an additional code, where applicable, to identify:
- exposure to environmental tobacco smoke (Z77.22)
- exposure to tobacco smoke in the perinatal period (P96.81)
- history of tobacco use (Z87.891)
- occupational exposure to environmental tobacco smoke (Z57.31)
- tobacco dependence (F17.-)
- tobacco use (Z72.0).
Asthma
The terminology used to describe asthma has been updated to reflect the current clinical classification. The term reactive airway disease is considered synonymous with asthma. The terms included in the codes to describe asthma are intermittent, mild, and three degrees of persistent: mild persistent, moderate persistent, and severe persistent.
| Asthma severity | Frequency of daytime symptoms |
| Intermittent | Less than or equal to two times per week |
| Mild persistent | More than two times per week |
| Moderate persistent | Daily. May restrict physical activity |
| Severe persistent | Throughout the day. Frequent severe attacks |
| limiting the ability to breathe |
Intrinsic (nonallergic) and extrinsic (allergic) asthma are both classified to J45.909, Unspecified asthma, uncomplicated.
The inclusion terms that appear under the category heading J45, Asthma, include allergic (predominantly) asthma, allergic bronchitis NOS, allergic rhinitis with asthma, atopic asthma, extrinsic allergic asthma, hay fever with asthma, idiosyncratic asthma, intrinsic nonallergic asthma, and nonallergic asthma.
Conditions that are not classified to category J45, Asthma, included in the Excludes1 are detergent asthma (J69.8), eosinophilic asthma (J82), lung diseases due to external agents (J60-J70), miner’s asthma (J60), wheezing NOS (R06.2), and wood asthma (J67.8).
The Excludes2 note includes conditions that can be coded with Asthma J45 category codes, specifically: asthma with chronic obstructive pulmonary disease (J44.9), chronic asthmatic (obstructive) bronchitis (J44.9), and chronic obstructive asthma (J44.9).
Fourth and fifth characters subcategories
The following subcategories describe the specific types of asthma along with the clinical status:
J45.2 Mild intermittent asthma
J45.20 Mild intermittent asthma, uncomplicated
Mild intermittent asthma NOS
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
Mild persistent asthma NOS
J45.31 Mild persistent asthma with (acute) exacerbation
J45.32 Mild persistent asthma with status asthmaticus
J45.4 Moderate persistent asthma
J45.40 Moderate persistent asthma, uncomplicated
Moderate persistent asthma NOS
J45.41 Moderate persistent asthma with (acute) exacerbation
J45.42 Moderate persistent asthma with status asthmaticus
J45.5 Severe persistent asthma
J45.50 Severe persistent asthma, uncomplicated
Severe persistent asthma NOS
J45.51 Severe persistent asthma with (acute) exacerbation
J45.52 Severe persistent asthma with status asthmaticus
J45.9 Other and unspecified asthma
J45.90 Unspecified asthma
Asthmatic bronchitis NOS
Childhood asthma NOS
The fifth digit subclassification describes whether the patient was in status asthmaticus or suffered what may be described as an exacerbation or acute exacerbation of asthma. Acute exacerbation or with exacerbation is an increase in the severity of the diseases of any of its signs or symptoms, such as wheezing or shortness of breath (SOB). Status asthmaticus is an acute asthmatic attack in which the degree of bronchial obstruction is not relieved by usual treatments.
Let’s practice! How do you code the following encounter?
A 45-year-old female with a history of tobacco use is being seen because of severe persistent with acute exacerbation.
J45.51 Severe persistent asthma with (acute) exacerbation
Z87.891 History of tobacco use
Rationale: There are categories of the three degrees of persistent asthma, with the ability to identify with or without exacerbation and status asthmaticus. At the beginning of the Chapter, the instructional guideline appears that instructs the professional to use an additional code to identify the history of tobacco use.
Judy Monestime, MBA, CDIP, CPC, is an AHIMA-approved ICD-10-CM/PCS trainer.
