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Icd-10 Code For Severe Asthma

Coding Spotlight: Providers Guide To Coding Respiratory Diseases

Let’s Talk About Asthma: ICD-10 Coding

Feb 1, 2020State & Federal / Medicaid

Category: Medicaid

ICD-10-CM coding

Respiratory diseases are classified in categories J00 through J99 in Chapter 10, Diseases of the Respiratory System of the ICD-10-CM Official Guidelines for Coding and Reporting.


Pneumonia is coded in several ways in ICD-10-CM. Combination codes that account for both pneumonia and the responsible organism are included in Chapter 1, Certain Infectious And Parasitic Diseases and Chapter 10, Diseases of the Respiratory System. Examples of appropriate codes for pneumonia include:

  • J15.0 pneumonia due to Klebsiella
  • J15.211 pneumonia due to Staphylococcus aureus
  • J11.08 + J12.9 viral pneumonia with influenza.

According to ICD-10-CM instructions, when coding J15:

  • Code first associated influenza, if applicable
  • Code also associated abscess, if applicable

Other types of pneumonia are coded as manifestations of underlying infections classified in chapter 1 two codes are required in such cases. Examples of this dual classification coding include I00 + J17 pneumonia in rheumatic fever. When the diagnostic statement is pneumonia without any further specification and the organism is not identified, the assigned code is J18.9 pneumonia, unspecified organism.

ICD-10-CM classifies influenza as the following categories:

  • J09 due to certain identified influenza viruses
  • J10 due to other identified influenza virus
  • J11 due to unidentified influenza virus.

Severity Key To Coding Asthma Encounters

Make sense of fifth digits to complete the picture.

Asthma is probably one of the most common conditions your pediatric practice diagnoses and treats. But no matter how familiar you are with the J45 code set, it’s always a good idea to remind yourself what makes the codes so specific.

Coding different asthma conditions accurately is simple if you follow the National Heart, Lung and Blood Institute guidelines for asthma diagnoses and know the fifth digit ICD-10 codes for each degree of severity.

So, take a deep breath, read on, and refresh your asthma coding knowledge.

First, Ask Intermittent or Persistent Mild, Moderate or Severe

Unlike many ICD-10 codes, the J45 code set uses the severity of the symptoms rather than the etiology of the condition as its subdivisions. This is consistent with the current asthma guidelines determined by the NHLBI, which classifies the conditions this way.

The chart shows that the condition has four different states – mild intermittent, mild persistent, moderate persistent, and severe persistent – that correspond exactly with the following four code sets:

  • J45.2, Mild intermittent asthma …
  • J45.4, Moderate persistent asthma …
  • J45.5, Severe persistent asthma …

A fifth code, J45.9 is reserved for forms of the condition that do not fit neatly into the established categories, such as asthmatic bronchitis, childhood asthma, or exercise-induced bronchospasm.

Then, Add 0, 1, or 2 for Full Reimbursement

What Happens To Our Lungsduring Asthma Attack:

During asthma attack, muscles around the airway gets tighten and the lining inside the airways becomes swollen and produce extra mucus. This makes airway to become narrow and partially block airflow in and out of air sacs.

Below picture gives a clear understanding of the position of lungs , normal airway and airway during asthma attack .

Apart from knowing the symptoms and doing a lung physical examination the physician will also do few test measures like X-ray, spirometry, allergy testing, nitric oxide breath test or peak flow to determine the type of asthma and its severity. Hence a coder should definitely pay attention to these areas as well.

Also Check: Moderate Persistent Asthma With Exacerbation

Drg Mapping Rules For J4550

Diagnostic codes are the first step in the DRG mapping process.

The patients primary diagnostic code is the most important. Assuming the patients primary diagnostic code is J45.50, look in the list below to see which MDCs Assignment of Diagnosis Codes is first. That is the MDC that the patient will be grouped into.

From there, check the subsections of the MDC listed. The patient will be mapped into the first subsection for which the treatment performed on the patient meet the listed requirements of that subsection.

DRG grouping rules are adjusted each year, so make sure to check the rules for the fiscal year of the patients discharge date.

Upper Respiratory Tract Infection


The upper airway is defined as the all the structures connecting the glottis to the mouth and nose. The most common upper respiratory tract infection is the common cold. However, infections of specific organs of the upper respiratory tract such as sinusitis, tonsillitis, otitis media, pharyngitis and laryngitis are also considered upper respiratory tract infections.

Epiglottitis is a bacterial infection of the larynx which causes life-threatening swelling of the epiglottis with a mortality rate of 7% in adults and 1% in children.Haemophilus influenzae is still the primary cause even with vaccinations. Symptoms include drooling, stridor, difficulty breathing and swallowing, and a hoarse voice.

Croup is a viral infection of the vocal cords typically lasting five to six days. The main symptom is a barking cough and low grade fever. On an x-ray, croup can be recognized by the steeple sign, which is a narrowing of the trachea. It most commonly occurs in winter months in children between the ages of 3 months and 5 years. A severe form caused by bacteria is called bacterial tracheitis.

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What Happens When Your Airways Are Sore

If you have asthma, the inside walls of your airways become sore and swollen. That makes them very sensitive, and they may react strongly to things that you are allergic to or find irritating. When your airways react, they get narrower and your lungs get less air.symptoms of asthma include. wheezing.

Severe Persistent Asthma Uncomplicated

Chapter 10 – Diseases of the respiratory system » Chronic lower respiratory diseases » Severe persistent asthma, uncomplicated

Hierarchy Tree View


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What Is Asthma Exacerbation

Asthma exacerbation: It is nothing but an acute increase of symptoms in a person with asthma. This can be coded only with the Physician diagnosis. Status asthmatics : Another term for this is severe asthma exacerbation. It is considered as severe as this may lead to even respiratory failure due to hypoxemia.

What Tests Are Done To Determine Asthma

ICD-10 Codes for Documenting Asthma

Apart from knowing the symptoms and doing a lung physical examination the physician will also do few test measures like X-ray, spirometry, allergy testing, nitric oxide breath test or peak flow to determine the type of asthma and its severity. Hence a coder should definitely pay attention to these areas as well.

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Sas Code For Calculation Of Asthma Rates By Age Group And Year

    See below for SAS code for calculation of asthma rates by age group and year .Validated work done by Kozyrskyj et al. for children has a slightly different requirement for prescriptions over time. The additional criteria in the drug definition for children is used to help remove individuals with childhood wheezing. The definition is at least one prescription for an inhaled corticosteroid or Chromone or Ketotifen concomitant with an inhaled or oral beta-agonist, or two or more prescriptions for an inhaled or oral beta-agonist. Each of these groups of drugs is identified in the provided code.

Who Is At Risk For Asthma

Asthma affects people of all ages, but it often starts during childhood. Certain factors can raise your risk of having asthma:

  • Being exposed to secondhand smoke when your mother is pregnant with you or when you are a small child
  • Being exposed to certain substances at work, such as chemical irritants or industrial dusts
  • Genetics and family history. You are more likely to have asthma if one of your parents has it, especially if its your mother.
  • Race or ethnicity. Black and African Americans and Puerto Ricans are at higher risk of asthma than people of other races or ethnicities.
  • Having other medical conditions such as allergies and obesity
  • Often having viral respiratory infections as a young child
  • Sex.

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    Common Terms Found In Medical Record Related To Asthma:

    Asthma exacerbation: It is nothing but an acute increase of symptoms in a person with asthma. This can be coded only with the Physician diagnosis.

    Status asthmatics : Another term for this is severe asthma exacerbation. It is considered as severe as this may lead to even respiratory failure due to hypoxemia. As soon as a patient comes to emergency room with asthma symptoms, physician treats initially with medicines such as bronchodilators. If patient has status asthmatics they do not respond to these medicines.

    Inhaler : Medicine filled inhalers are given to patient to use comfortably at any place when symptoms occurs suddenly.

    Nebulizer : Electricity powered machine filled with liquid medication which turns to mist and the patient breath in.

    Nasal spray : A bottle with liquid medicine made with the ease of spraying to nose.

    PFT : Pulmonary Function Test, use to check the lung function by measuring lung volume, capacity, rates of flow and gas exchange.

    What Are The Treatments For Asthma

    Icd 10 Code For Asthma Exacerbation

    If you have asthma, you will work with your health care provider to create a treatment plan. The plan will include ways to manage your asthma symptoms and prevent asthma attacks. It will include

  • Strategies to avoid triggers. For example, if tobacco smoke is a trigger for you, you should not smoke or allow other people to smoke in your home or car.
  • Short-term relief medicines, also called quick-relief medicines. They help prevent symptoms or relieve symptoms during an asthma attack. They include an inhaler to carry with you all the time. It may also include other types of medicines which work quickly to help open your airways.
  • Control medicines. You take them every day to help prevent symptoms. They work by reducing airway inflammation and preventing narrowing of the airways.

    If you have a severe attack and the short-term relief medicines do not work, you will need emergency care.

    Your provider may adjust your treatment until asthma symptoms are controlled.

    Sometimes asthma is severe and cannot be controlled with other treatments. If you are an adult with uncontrolled asthma, in some cases your provider might suggest bronchial thermoplasty. This is a procedure that uses heat to shrink the smooth muscle in the lungs. Shrinking the muscle reduces your airways ability to tighten and allows you to breathe more easily. The procedure has some risks, so its important to discuss them with your provider.

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    What Causes Asthma

    The exact cause of asthma is unknown. Genetics and your environment likely play a role in who gets asthma.

    An asthma attack can happen when you are exposed to an asthma trigger. An asthma trigger is something that can set off or worsen your asthma symptoms. Different triggers can cause different types of asthma:

    • Allergic asthma is caused by allergens. Allergens are substances that cause an allergic reaction. They can include
    • Pollen from grass, trees, and weeds
    • Waste from pests such as cockroaches and mice
  • Nonallergic asthma is caused by triggers that are not allergens, such as
  • Breathing in cold air
  • Infections such as colds and the flu
  • Outdoor air pollution
  • Occupational asthma is caused by breathing in chemicals or industrial dusts at work
  • Asthma triggers may be different for each person and can change over time.

    What Are The Icd

    Unspecified asthma, uncomplicated ranks at the top of our list with a total of 8,809,971 diagnoses in 2021. The ICD-10 code for asthma, unspecified is J45909.

    This chronic condition has a considerable lead in both diagnoses and charges compared to all other ICD-10 codes. While many factors could contribute to why J45909 ranks number one, a likely cause could be problems with documentation. Many of the other codes on this list detail asthma of various degrees of chronicity and severity. A lack of proper documentation, however, could cause medical coders to resort to classifying the diagnosis as unspecified asthma, uncomplicated.

    An asthma attack, also called asthma, exacerbation, is another common diagnosis with a few top positions on our list. The ICD-10 codes for these diagnoses are J45901, J4521, J4541 and J4531.

    Its also important to note that some physicians may regard asthma classifications as fluid. While this condition cant be cured, a patients lifestyle can make the symptoms of asthma easier or harder to manage. Eliminating smoking habits and exercising regularly, alongside medical treatment, can potentially improve a patients condition. As a result, the classification of asthma a patient is diagnosed with can change over years and decades.

    Also Check: What To Do For Asthma Without Inhaler

    How Is Asthma Diagnosed

    Your health care provider may use many tools to diagnose asthma:

  • Medical history
  • Lung function tests, including spirometry, to test how well your lungs work
  • Tests to measure how your airways react to specific exposures. During this test, you inhale different concentrations of allergens or medicines that may tighten the muscles in your airways. Spirometry is done before and after the test.
  • Peak expiratory flow tests to measure how fast you can blow air out using maximum effort
  • Fractional exhaled nitric oxide tests to measure levels of nitric oxide in your breath when you breathe out. High levels of nitric oxide may mean that your lungs are inflamed.
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    Lower Respiratory Tract Infection

    ICD-10 Codes for Reporting COPD and Asthma

    The most common lower respiratory tract infection is pneumonia, an infection of the lungs which is usually caused by bacteria, particularly Streptococcus pneumoniae in Western countries. Worldwide, tuberculosis is an important cause of pneumonia. Other pathogens such as viruses and fungi can cause pneumonia, for example severe acute respiratory syndrome, COVID-19 and pneumocystis pneumonia. Pneumonia may develop complications such as a lung abscess, a round cavity in the lung caused by the infection, or may spread to the pleural cavity.

    Poor oral care may be a contributing factor to lower respiratory disease, as bacteria from gum disease may travel through airways and into the lungs.

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    What Are The Symptoms Of A Bronchial Infection

    Symptoms include wheezing, coughing, tightness in the chest, shortness of breath, and rapid breathing. An attack may be brought on by pet hair, dust, smoke, pollen, mold, exercise, cold air, or stress. A chronic respiratory disease manifested as difficulty breathing due to the narrowing of bronchial passageways.

    Coding Tip: Chronic Obstructive Pulmonary Disease And Asthma

    Kim Boy, RHIT, CDIP, CCS, CCS-P

    This Coding Tip was updated on 07/26/2022

    Below are some definitions for clarification:

    Chronic Obstructive Pulmonary Disease is a chronic inflammatory lung disease that causes obstructed flow of air from the lungs. The disease is progressive in nature and typically will worsen over time. The most common cause of COPD is smoking tobacco. COPD is increasingly being used to document lung disease. The coder must review the record for further specificity of the disease. Emphysema and chronic bronchitis are the two main conditions of COPD. COPD can also be further clarified to be with acute exacerbation.

    Asthma is an inflammatory condition in which the airways narrow and swell and extra mucous is produced. There is no cure for asthma, but symptoms may be prevented by avoiding triggers and using prescribed medications. The cause of asthma is either environmental or genetic. If asthma is present before age 12, the cause is most likely from genetics. If asthma presents after age 12, the cause is more likely to be environmentally induced. Asthma can also be further clarified as to severity as well as status asthmaticus or acute exacerbation.

    Status asthmaticus is described as asthma with acute symptoms that do not respond to standard treatment including the use of steroids and bronchodilators.

    Exacerbation is a sudden worsening of a disease and typically last several days.


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    Diseases Of The Respiratory Systemnote

  • When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site .
    • certain conditions originating in the perinatal period
    • certain infectious and parasitic diseases
    • complications of pregnancy, childbirth and the puerperium
    • congenital malformations, deformations and chromosomal abnormalities
    • endocrine, nutritional and metabolic diseases
    • injury, poisoning and certain other consequences of external causes
    • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
    • code, where applicable, to identify:
    • exposure to environmental tobacco smoke
    • exposure to tobacco smoke in the perinatal period
    • history of tobacco dependence
    • occupational exposure to environmental tobacco smoke
  • bronchitis due to chemicals, gases, fumes and vapors
    • cystic fibrosis
  • Form of bronchial disorder associated with airway obstruction, marked by recurrent attacks of paroxysmal dyspnea, with wheezing due to spasmodic contraction of the bronchi.

    Occupational Exposure To Environmental Tobacco Smoke

    Icd 10 Code For Asthma Copd Overlap Syndrome
      20162017201820192020202120222023Billable/Specific CodePOA Exempt
  • F17.200 Nicotine dependence, unspecified, uncomplicat…
  • F17.201 Nicotine dependence, unspecified, in remissio…
  • F17.203 Nicotine dependence unspecified, with withdra…
  • F17.208 Nicotine dependence, unspecified, with other …
  • F17.209 Nicotine dependence, unspecified, with unspec…
  • F17.21 Nicotine dependence, cigarettes
  • F17.210 Nicotine dependence, cigarettes, uncomplicate…
  • F17.211 Nicotine dependence, cigarettes, in remission…
  • F17.213 Nicotine dependence, cigarettes, with withdra…
  • F17.218 Nicotine dependence, cigarettes, with other n…
  • F17.219 Nicotine dependence, cigarettes, with unspeci…
  • F17.22 Nicotine dependence, chewing tobacco
  • F17.220 Nicotine dependence, chewing tobacco, uncompl…
  • F17.221 Nicotine dependence, chewing tobacco, in remi…
  • F17.223 Nicotine dependence, chewing tobacco, with wi…
  • F17.228 Nicotine dependence, chewing tobacco, with ot…
  • F17.229 Nicotine dependence, chewing tobacco, with un…
  • F17.29 Nicotine dependence, other tobacco product
  • F17.290 Nicotine dependence, other tobacco product, u…
  • F17.291 Nicotine dependence, other tobacco product, i…
  • F17.293 Nicotine dependence, other tobacco product, w…
  • F17.298 Nicotine dependence, other tobacco product, w…
  • F17.299 Nicotine dependence, other tobacco product, w…
    • 20162017201820192020202120222023Billable/Specific CodePOA Exempt

    Applicable To

  • type 1 excludes

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