Acute or Chronic Bronchitis
Bronchitis is a respiratory disease in which there is inflammation of the mucus membrane in the lungs’ bronchial passages. The disease comes in two forms: Acute or Chronic Bronchitis. As the irritated membrane swells and grows thicker, it narrows or shuts off the tiny airways in the lungs, resulting in coughing that may be accompanied by phlegm and breathlessness.
- Acute which lasts from one to three weeks and;
Acute bronchitis may be responsible for the hacking cough and phlegm production that sometime accompany an upper respiratory infection. In most cases, the causative agent is viral in origin, but sometimes can be caused by bacteria.
If otherwise in good health, the mucus membrane should return to normal after recovered from the initial lung infection, which usually lasts for several days.
Acute bronchitis codes are further categorized by causal organism. For example:
- Acute bronchitis due to Mycoplasma pneumonia J20.0
- Acute bronchitis due to parainfluenza virus J20.4
- Acute bronchitis due to echovirus J20.7
- Chronic lasting at least 3 months of the year for two years in a row
Chronic bronchitis codes are broken down further as simple, mucopurulent, or mixed. For example:
- Simple chronic bronchitis J41.0
- Mucopurulent chronic bronchitis J41.1
- Mixed simple and mucopurulent chronic bronchitis J41.8
People with asthma may also have a condition called as asthmatic bronchitis, inflammation of the lining of the bronchial tubes.
Chronic bronchitis is a serious long-term disorder that often requires regular medical treatment.
Chronic bronchitis is one of two main types of a COPD (Chronic Obstructive Pulmonary Disease). The other main form of COPD (Chronic Obstructive Pulmonary Disease) is emphysema. Both forms of COPD causes difficulty in breathing.
Causes of Bronchitis
Acute bronchitis is generally caused by:
- Lung infections, of which 90% cases are viral in origin
- Repeated attacks of acute bronchitis, which weaken and irritate bronchial airways over time, can result in chronic bronchitis
- Industrial pollution is another cause of acute bronchitis.
Chronic bronchitis is caused by:
- Heavy, long-term cigarettesmoking, which irritates the bronchial tubes and causes them to produce excess mucus.
- The symptoms of chronic bronchitis are also worsened by high concentrations of sulfur dioxide and other pollutants in the atmosphere
In ICD-10-CM there are five documentation requirements for bronchitis:
- Type: These include:
- Simple,
- Mucopurulent,
- Fibrinous,
- Membranous,
- Purulent, or septic bronchitis
- Temporal factors (or parameters): These include
- Acute,
- Chronic,
- Acute on chronic, and recurrent
- Infectious agent, such as:
- Mycoplasma pneumonia
- Hemophilus influenza
- Streptococcus
- Coxsackie virus
- Parainfluenza virus
- Respiratory syncytial virus
- Rhinovirus
- Echovirus
- Other specified organisms
- Associated condition: These may include bronchospasm, tracheitis, and tracheobronchitis. Associated conditions are listed in the ?includes? note at the beginning of each code category. To support medical necessity for services provided, the conditions nevertheless should be documented
- Cause or contributing factors: If the documentation includes tobacco smoke exposure (occupational or environmental), tobacco dependence, tobacco use, or history of tobacco use an additional code must be assigned
- Each subcategory includes an unspecified code. If documentation does not specify a time parameter you must assign J40Bronchitis, not specified as acute or chronic (this should be avoided, if possible)
Examples to explain documentation requirements for Bronchitis are as follows;
Example 1: Five-month-old Jack is brought in by his father for a hospital follow-up visit. Jack was taken to the Emergency Department by his mother and admitted due to breathing problems. Respiratory viral panel showed Jack to have acute bronchitis due to RSV. He had an nine-day hospital stay. He is doing very well today, with minimal cough and easy breathing.
Correct coding for this encounter will be is J20.5 which is Acute bronchitis due to respiratory syncytial virus.
Example 2: Joyce presents for recheck on her bronchitis. She states she has less short of breath when walking upstairs this week. She says the medication Albuterol is helping her breathing.
This encounter indicates that the patient presents for a recheck on her bronchitis. Because there is no indication if the condition is acute or chronic, the unspecified code J40 must be assigned.
Example 3: Jane presents for a recheck on her simple chronic bronchitis. She states she has less short of breath when walking up stairs this week. She says the Albuterol is helping her breathing.
With only the addition of the words ?simple chronic? to the second example, a more specific code, J41.0 which is Simple chronic bronchitis, may be assigned.