COPD with acute lower respiratory infection J44.0

lconaway@altoonaregional.org

We have a pt that presents with COPD, pneumonia and a query was placed for acute resp failure. The doc agreed. With the new ICD-10 code of J44.0, our coders say that the COPD HAS to be the principal dx with pneumonia sequenced as a secondary. Is this correct? (Given both the COPD and PNA meet the definition of PDX)
Here is her rationale: No we can not use pna as pdx when copd is also present. You have to go with either the J96.01 resp failure or J44.0 as pdx. Under J44.0 there is a use additional code to identify infection and below are the guidelines for use additional code and code also. So basically when you see a use additional code, the code it falls under should be first and the additional code should be second. If you are comfortable with the respiratory failure as pdx then the seq would be correct.

Please advise! Thank you. LeeAnn Conaway, RN, CCRN, CCDS
Supervisor of CDI/Coding at UPMC

vanessa.falkoff

I know for financial reasons we try to go towards COPD w PNA rather than PNA w COPD, but have not heard this rationale before.

Vanessa Falkoff RN
Clinical Documentation Improvement Coordinator
University Medical Center of Southern Nevada
1800 W Charleston Blvd
Las Vegas, NV
vanessa.falkoff@umcsn.com
office 702-383-7322

Compassion * Accountability * Respect * Integrity

lconaway@altoonaregional.org

I agree and that is typically how we sequenced it with ICD-9. This J44.0 is a new code that states to use the COPD and "code also" the infection. I think this refers more to a pt with COPD and bronchitis as COPD and pneumonia don't have the same interrelationship and are two completely different and independent conditions.

evanspx@sutterhealth.org

I believe the reference to 'infection' here is referring to something such as a Virus that may be responsible for an 'acute exacerbation' of COPD, but I also believe that Pneumonia is a separate clinical event and that the reference to code the additional 'infection' is not referring to something such as a pneumonia.





Decision should be made based upon the Definition of the Principal Diagnosis..as below – one must consider the stated acuity of each condition, along with the intensity of the w/u and therapy rendered to the COPD ‘versus’ a PNEUMONIA.



I-10 Guidelines state:





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Also, this from I-9, which is still relevant and applicable:


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Paul Evans, RHIA, CCS, CCS-P, CCDS



Manager, Regional Clinical Documentation

Sutter West Bay

633 Folsom St., 7th Floor, Office 7-044

San Francisco, CA 94107

Cell: 415.412.9421







evanspx@sutterhealth.org

lconaway@altoonaregional.org

Well said, Paul. Thanks for always being such a great resource on difficult issues.

LeeAnn Conaway, RN, CCRN, CCDS
Supervisor of CDI/Coding @ UPMC

renmeyer@sbcglobal.net

I’m glad you asked! We have the same situation where our coders states that the new code set J44.0 guides them to code pneumonia as secondary. It would be interesting to know how other organizations code/interpret it.

Renee, RN CCDS