Severe Persistent Asthma Uncomplicated
Chapter 10 – Diseases of the respiratory system » Chronic lower respiratory diseases » Severe persistent asthma, uncomplicated
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Definition And Literature Review
- Definition of AsthmaAsthma is an inflammatory disorder of the airways, characterized by periodic attacks of wheezing, shortness of breath, chest tightness, and coughing. See MedlinePlus® – Health Topics – Asthma for more information.Literature ReviewIn Lix et al. , they performed a literature review and found that cases of asthma have been ascertained in administrative data using diagnosis codes alone and diagnosis codes along with prescription drug claims . Table 1 summarizes eight studies, published prior to 2006, that use administrative data to ascertain cases of asthma.Three of the studies used Manitoba data among these studies, two used only medical services/physician claims to identify asthma cases, while the third used a combination of hospital separations, medical services/physician claims, and prescription drug records to identify asthma cases. For the studies that reported validation results, estimates of sensitivity, specificity, and predictive values varied substantially.
How Is Asthma Diagnosed
Your health care provider may use many tools to diagnose asthma:
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Tabular List Of Diseases And Injuries
The Tabular List of Diseases and Injuries is a list of ICD-10 codes, organized “head to toe” into chapters and sections with coding notes and guidance for inclusions, exclusions, descriptions and more. The following references are applicable to the code J45.50:
Inclusion Terms
- Severe persistent asthma NOS
Lower Respiratory Tract Infection
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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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.
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.
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Occupational Exposure To Environmental Tobacco Smoke
- 2016201720182019202020212022Billable/Specific CodePOA Exempt
- 2016201720182019202020212022Billable/Specific CodePOA Exempt
Applicable To
type 1 excludes
What Are The Treatments For Asthma
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
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 airway’s ability to tighten and allows you to breathe more easily. The procedure has some risks, so it’s important to discuss them with your provider.
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Drg Mapping Rules For J4550
Diagnostic codes are the first step in the DRG mapping process.
The patient’s primary diagnostic code is the most important. Assuming the patient’s primary diagnostic code is J45.50, look in the list below to see which MDC’s “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 patient’s discharge date.
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.
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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.
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.
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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:
Sex.
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.
References:
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What Are The Symptoms Of Asthma
The symptoms of asthma include
These symptoms can range from mild to severe. You may have them every day or only once in a while.
When you are having an asthma attack, your symptoms get much worse. The attacks may come on gradually or suddenly. Sometimes they can be life-threatening. They are more common in people who have severe asthma. If you are having asthma attacks, you may need a change in your treatment.
Diseases Of The Respiratory Systemnote
- 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
- cystic fibrosis
- : New code
- 2017
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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
- Dust mites
- Pollen from grass, trees, and weeds
- Waste from pests such as cockroaches and mice
Asthma triggers may be different for each person and can change over time.
What Is Asthma
Asthma is a chronic lung disease. It affects your airways, the tubes that carry air in and out of your lungs. When you have asthma, your airways can become inflamed and narrowed. This can cause wheezing, coughing, and tightness in your chest. When these symptoms get worse than usual, it is called an asthma attack or flare-up.
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