Clearing the Air on COPD – Coding Considerations

When we think of November we think of fall and, most likely, Thanksgiving, but did you know that November 2025 is Chronic Obstructive Pulmonary Disease (COPD) awareness month? 

Tomorrow, November 19, is World COPD Day for 2025.  This is the global Initiative for Chronic Obstructive Lung Disease.  This group, along with healthcare professionals and patient groups, organized World COPD Day and have chosen the theme “Short of Breath, think COPD” for 2025. This is worldwide with more than 50 countries.  Organizers hope to raise awareness and share information.  World COPD Day was first recognized in 2002. 

With this year’s theme, GOLD, organizers hope to bring attention to the fact that COPD is not always diagnosed correctly.  GOLD further notes that patients may suffer from incorrect treatment or no treatment at all as result of under-diagnosing as well as misdiagnosis.  This is a definite problem since they note COPD is the third leading cause of death worldwide. 

GOLD notes that if patients are correctly diagnosed earlier, it would have a significant impact on public health, resulting in better outcomes and quality of life for those who suffer with COPD. 

The GOLD website notes, “A diagnosis of COPD should be considered in any patient who has shortness of breath, chronic cough or sputum production, a history of recurrent lower respiratory infections and/or a history of exposure to risk factors like tobacco, cooking fuels, or occupational hazards.”

As coders we know COPD is always a coding concern.  We, of course, have our guidelines for help as well as many Coding Clinic answers.  We also had an instructional note change with our last Inpatient Prospective Payment System (IPPS) update which changes the way we code COPD with chronic bronchitis. 

There was once an excludes 1 note at J44 for J42, chronic bronchitis NOS.  As of Oct. 1, 2025, this has been changed to an excludes 2 instructional note. 

This means we can assign COPD J44 codes with J42.  This will be a change in thinking for coders. Make sure you and your coding team are aware of this change and all other October 1 updates. 

How we code COPD with asthma continues to be an area where we still see confusion.  Coding Clinic Second Quarter 2024 answers a question about some coder confusion on Alphabetic Index and Tabular List entries regarding COPD and asthma.  Coding Clinic instructs us to assign J44.89.  It further notes that no additional code is necessary unless the asthma is specified or if it is in exacerbation.  While this appears to be very straightforward guidance, we still see confusion in this area. 

Either the coder thinks the J44.89 is the only code needed regardless of what is documented, or the coder thinks you have to have two codes assigned regardless of the documentation.  It may help to think of what we are assigning for, in other words, is there something documented that isn’t represented by the assigned code. 

For example, if COPD and mild intermittent asthma is documented, code J44.89 by itself doesn’t tell the whole story.  You need the additional J45.20 to identify that the asthma is specified as mild intermittent. 

Similarly, if COPD and asthma in exacerbation is documented, without the J45.901 assigned, you would not identify that the asthma is in an exacerbated state.  It is also important to note that adding the J45.909 unspecified asthma code does not give any additional information.  Unspecified is not a type or severity and doesn’t add to the story. 

The codes we assign tell the story, making us as coders the storytellers.