Health Information Management

Linking smoking and COPD

HIM-HIPAA Insider, June 30, 2014

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Jeff comes in to the Fix ‘Em Up Clinic complaining of shortness of breath, a persistent cough, tightness in his chest, and frequent respiratory infections. He tells Nurse Nosey that he smokes a pack of cigarettes a day and has for the past 20 years.

After examining Jeff, Dr. Sniffle diagnoses chronic obstructive pulmonary disease (COPD). He also notes that Jeff is a smoker. No wonder Jeff has trouble breathing.
When we look up COPD in the ICD-10-CM Alphabetic Index (under disease, pulmonary, chronic), we are directed to the J44 (other chronic obstructive pulmonary disease) code series. We find lots of interesting notes under J44. We have Includes, Excludes1, Code also, and Use additional code notes.
We’re going to just look at the Use additional code notes.
Use additional code to identify:
  • exposure to environmental tobacco smoke (Z77.22)
  • history of tobacco use (Z87.891)
  • occupational exposure to environmental tobacco smoke (Z57.31)
  • tobacco dependence (F17.-)
  • tobacco use (Z72.0)
We know Jeff is a smoker, but which additional code should we use? Dr. Sniffle didn’t document dependence, use, or abuse, just that Jeff was a smoker.
The ICD-10-CM Alphabetic Index to the rescue! If you look up smoker in the index, you are directed to see dependence, drug, nicotine. It doesn’t matter how much Jeff smokes, just that he is a smoker, according to Nelly Leon-Chisen, RHIA, director of coding and classification for the American Hospital Association in Chicago.
What does matter is whether Dr. Sniffle documents a link between Jeff’s smoking and his COPD. If Dr. Sniffle notes that Jeff’s smoking caused his COPD, we would report:
  • J44.9, chronic obstructive pulmonary disease, unspecified
  • F17.218, nicotine dependence, cigarettes, with other nicotine-induced disorders
However, if Dr. Sniffle does not document a link between Jeff’s smoking and COPD, we cannot assume one (Coding Clinic, Fourth Quarter 2013, p. 109). That changes our codes to:
  • J44.9, chronic obstructive pulmonary disease, unspecified
  • F17.210, nicotine dependence, cigarettes, uncomplicated
The main cause of COPD is smoking (according to WebMD and the Mayo Clinic). Even so, we can’t assume the connection. Jeff’s COPD could possibly be caused by something else. If you aren’t sure, drop Dr. Sniffle a query and ask whether he can specify the cause of Jeff’s COPD.
This article originally appeared on HCPro’s ICD-10 Trainer blog.

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