ICD 10 code for COPD (Chronic Obstructive Pulmonary Disease)
According to ICD-10 classification, obstructive lung diseases have been classified to following main categories.
- J43 for Emphysema
- J44 for Other Chronic Obstructive Diseases
- J45 for Asthma
COPD has been classified under category J44 in ICD-10 codes.
Main Code for COPD:
The primary ICD 10 code for COPD (Chronic Obstructive Pulmonary Disease) is J44. This is the main ICD 10 code one would typically use to indicate a diagnosis of COPD.
Subcodes under COPD:
ICD-10 provides additional subcodes under J44 to specify different aspects and severity of COPD. These subcodes can include:
- J44.0: Chronic obstructive pulmonary disease with acute lower respiratory infection
- J44.1: Chronic obstructive pulmonary disease with (acute) exacerbation
- J44.8: Other specified chronic obstructive pulmonary disease
- J44.9: Chronic obstructive pulmonary disease, unspecified
Use of Subcodes: The subcodes help provide more specific information about the COPD diagnosis. For example, J44.0 would be used if the patient has COPD and is also experiencing an acute lower respiratory infection. J44.1 is used for cases where there is an acute exacerbation of COPD.
Unspecified Code: J44.9 is used when the specific nature of the COPD is not further specified, which might occur in some cases.
When coding for COPD, it's important to use the most accurate and specific code that reflects the patient's condition and any associated factors. Proper coding helps with billing, research, and healthcare planning. Keep in mind that ICD-10 codes are regularly updated, so it's essential to use the most current version for accurate coding.
COPD with co-existing Asthma
ICD 10 code for COPD with unspecified asthma is J44.9. When the type of asthma has been specified, then two ICD 10 codes are required i.e ICD 10 code from for COPD from J44 & code from category J45 to report types of asthma
Type of Asthma subcategories under J45 include the following:
- J45.2- Mild intermittent asthma
- J45.3- Mild persistent asthma
- J45.4- Moderate persistent asthma
- J45.5- Severe persistent asthma
- J45.9- Other and unspecified asthma
Acute Exacerbation of COPD
Acute Exacerbation of COPD means progressive worsening and flare up of the COPD symptoms like worsening of cough with profuse sputum & increase breathlessness.
The ICD 10 code for Acute Exacerbation of COPD is J44.1.
COPD with Acute bronchitis
Two ICD 10 codes are assigned for COPD with acute bronchitis.
- J44.0 for Chronic obstructive pulmonary disease with
(acute) lower respiratory infection
- J20.9 for Acute bronchitis, unspecified
COPD with bronchiectasis
The ICD 10 code J44 excludes COPD with bronchiectasis. ICD 10 code from category J47 is only assigned for COPD with bronchiectasis.
Emphysema has been classified to category J43 under ICD 10 classification. Emphysema is a more specific type of COPD. Emphysema with chronic bronchitis refers to COPD & coded under category J44. Emphysema without chronic bronchitis coded to category J43 & sub types of J43 includes the following.
- J43.0 Unilateral pulmonary emphysema [MacLeod’s syndrome]
- J43.1 Panlobular emphysema
- J43.2 Centrilobular emphysema
- J43.8 Other emphysema
- J43.9 Emphysema, unspecified
Example of ICD 10 code assignment for COPD
Final diagnosis is COPD. The ICD 10 code for COPD is J44.9 (Chronic obstructive pulmonary disease, unspecified)
2. COPD & Asthma
Final diagnosis is COPD with asthma. The ICD 10 code for COPD with asthma is J44.9. If the types of asthma has been specified, then another code from category J45 will be assigned along with.
3. COPD with Asthma exacerbation
Final diagnosis is COPD with Asthma exacerbation. The ICD 10 codes for COPD with asthma exacerbation are J44.9 & J45.901. J44.9 for COPD, unspecified & J44.901 for Unspecified asthma with (acute) exacerbation.
4. Acute exacerbation of COPD
Final diagnosis is Acute exacerbation of COPD. The ICD 10 code for Acute exacerbation of COPD is J44.1 (COPD with acute exacerbation).
5. Emphysema and moderate persistent asthma
Final diagnosis is Emphysema & moderate persistent asthma. The ICD 10 code for Emphysema & moderate persistent asthma is J43.9 & J45.40. J43.9 is for Emphysema, unspecified and J45.40 for Moderate persistent asthma, uncomplicated
Since emphysema is a more specific type of COPD, ICD 10 code J43.9 is assigned rather than J44.9 (unspecified COPD).
6. COPD with acute bronchitis
Final diagnosis is COPD with acute bronchitis. The ICD 10 code for COPD with acute bronchitis is J44.0 & J20.9. ICD 10 code J44.0 is assigned for COPD with acute lower respiratory infection & ICD 10 code, J20.9 is assigned for Acute bronchitis, unspecified.
Chronic Obstructive Pulmonary Disease (COPD)
COPD is the Chronic Obstructive Pulmonary Disease characterized by persistent respiratory symptoms (Dyspnea & cough), airflow limitations and alveolar gas exchange abnormalities, usually due to long term exposure to noxious particles and gases.
The spectrum of COPD includes
- Chronic bronchitis
Chronic bronchitis is defined as cough and sputum production for at least 3 consecutive months for 2 years.
Emphysema is abnormal permanent dilation of the pulmonary air spaces distal to terminal bronchioles due to the destruction of alveolar walls.
Type of Emphysema
There are 4 types of emphysema
- Centrilobular emphysema
- Panlobular emphysema
- Paraseptal emphysema
- Irregular emphysema
Centrilobular emphysema is the most common type of Emphysema seen in smoker, usually affect upper lobes.
Panlobular emphysema is association with alpha 1 antitrypsin deficiency, usually affects lower lobes.
Paraseptal emphysema usually affects the periphery of lungs: distal alveoli. Bullae may rupture leading to pneumothorax
Risk factor for COPD
- Cigarette smoking
- Occupational exposure (Coal dust, Silica)
- Indoor air pollution
- Recurrent infection
- Premature birth
- Alpha 1 antitrypsin deficiency
- IgA deficiency
Etiology for Acute exacerbation of COPD
Viral respiratory infections arethemost common cause of AECOPD, among them Rhinovirus isthe most common cause of acute exacerbation ofCOPD.
Others viruses: SARS-CoV-2, influenza, RSV, parainfluenza, adenovirus
Bacterial infections: e.g., Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae
Symptoms of COPD
- Chronic cough with sputum production
- Breathlessness (initial on exertion, later continuous)
- Pursed lip breathing
- Prolonged expiratory phases
- Weight loss (in severe COPD)
- Cyanosis (due to hypoxia)
- Morning Headache (indicative of hypercapnia)
- Feature of complications of pneumothorax, right heart failure and respiratory failure
Signs of COPD
- Barrel shaped chest
- Reduced chest movement bilaterally
- Tachycardia, Tachypnea, Cyanosis
- Pursed lip breathing, Prolonged expiratory phases
- Intercostal & suprasternal recession, Supraclavicular fullness
- Prominence of accessory respiratory muscles (Sternocleidomastoid, Trapezius)
- Tracheal Tug may present, Cricosternal distance reduced
- Apex beat shifted downward
- Chest expansion reduced bilaterally
- Vocal fremitus reduced
- Hyper-resonant over whole lung field
- Liver dullness displacement
- Vesicular breath sound with prolonged expiration with ronchi/wheeze
- Vocal resonance is diminished
Feature of Complications
Type 1 Respiratory Failure
- Decreased O2 saturation
Type 2 Respiratory Failure
- Warm periphery
- Bounding pulse
- Flapping tremors
Cor pulmonale means right ventricular hypertrophy with or without heart failure
Right heart failure
- Pedal edema
- Raised JVP
- Tender hepatomegaly
Pulmonary Hypertension - Palpable P2 and loud P2
Right ventricular hypertrophy - Left parasternal heave & Epigastric pulsation
Investigation done in COPD
1. Spirometry to confirm air flow limitation: FEV1/FVC < 70%
2. Peak Expiratory Flow Rate (PEFR)
3. Serum Alpha 1 Anti-Trypsin level (in Younger patient)
4. Complete Blood Count (CBC) - to access anemia or polycythemia, eosinophilia count > 300 cells/microL, then start ICS.
5. Chest X ray
6. High resolution CT scan of chest for detection of emphysema
7. ECG for heart failure;
- Tall P wave (P pulmonale)
- Feature of Right ventricular hypertrophy
- Low voltage ECG in emphysema and pneumothorax
8. Arterial blood gas analysis and Pulse oximetry for assessment of respiratory failure. Obtain in patients with SO2 < 92% and/or acute illness (e.g., altered mental status, AECOPD)
9. Microbiological studies
- Testing for viral URTIs: Nasopharyngeal swab for respiratory viral panel and/or COVID-19 testing
- Sputum for AFB & Gram stain and culture
Chest X-ray finding of CPD
- Low flat diaphragm
- Tubular heart shaped
- Widening of intercostal spaces
- Increased in AP diameter (Lateral view)
Treatment of COPD
Cessation of smoking is the single most important factor.
1. Group A
Long acting bronchodilator
- Long acting beta agonist (LABA) eg. Salbumatol or Formoterol
- Or, Long acting muscarinic antagonist (LAMA) eg Tiotropium bromide
2. Group B: LABA plus LAMA combination therapy
3. Group E
LABA + LAMA + ICS (Inhaler corticosteroids) - Triple therapy
ICS are budesonide, beclomethasone, fluticasone.
Consider adding ICS if eosinophils count > 300 cells per microliters. Stop or reduce ICS dose if there is adverse effects eg. Pneumonia
4. Consider adding Antibiotics if bacterial infection Eg. Macrolide (Azithromycin). Other antibiotics (Board spectrum) are Levofloxacin, Moxifloxacin, etc.
5. Long term oxygen therapy (LTOT) > 15 hours/day [If PaO2 < 60 mm Hg or SaO2 < 88% at rest]
6. Vaccination: Influenza vaccine yearly and Pneumococcal vaccine
Surgical treatment for COPD are
- Surgical bullectomy
- Lung volume reduction surgery
Treatment of Acute exacerbation of COPD
1. Low concentration oxygen therapy (2L):Target SpO2 is 88 - 92%. If no response to nebulizer and steroid, consider NIPPV (Non invasive Positive pressure ventilation). BiPAP (Bilevel Positive Airway Pressure) commonly used.
2. Bronchodilator (Nebulization): SABA plus SAMA (Salbumatol & ipratropium bromide)
3. Systemic corticosteroids: Oral prednisolone (50 mg) for 5 days.
4. Antibiotics if infection (consider if worsening symptoms) as it decrease exacerbation. Eg: Macrolide (Eg. Azithromycin 500 mg 3 times weekly)
Route of administration of bronchodilator
- MDI (Metered dosed Inhaler)
Complication of COPD
- Respiratory Failure:
Type 1 Respiratory Failure (Hypoxia PaO2 < 60 mm Hg)
Type 2 Respiratory Failure (Hypoxia and Hypercapnia i.e PaO2 < 60 mm Hg & PaCO2 > 45 mm Hg)
- Cor pulmonale
- Acute exacerbation of COPD
- Spontaneous pneumothorax due to rupture of bullae)
- Secondary Polycythemia
Measure to improve survival inCOPD
- Cessation of smoking
- Long term oxygen therapy
Differential diagnosis of COPD
- Congestive Heart Failure