Alicia: COPD and emphysema.
If youíre not familiar with what COPD is and emphysema, itís just common respiratory
conditions.
It is progressive and it will make the patient ultimately just have difficulty in breathing.
Alicia: COPD is actually one of the hardest, I think, ICD 9 codes to find especially for
new students.
COPD stands for Chronic Obstructive Pulmonary Disease.
Itís 496.
If youíre going to memorize a code, thatís a good one to memorize because it is hard
to find.
Emphysema, 492.8 and asthma, 493.20.
If you noticedÖ sorry, I spelled that wrong, didnít I?
If you noticed that, all those are 49 codes.
When you get into coding, they all follow a numerical pattern which, as you do them
more, youíll notice that.
So these are 400 codes is what we call them.
COPD, you may have heard it again as Chronic Obstructive Pulmonary Disease or Chronic Obstructive
Asthma which means the airway swells and narrows.
Chronic Bronchitis is a constant cough with mucus actually, and emphysema which is the
destruction of the lungs over time.
The Chronic Obstructive Asthma and chronic bronchitis, that can get better and get worse.
But once you progress where the lung tissue is actually damaged then they state that itís
emphysema now.
So a person can have COPD that turned into emphysema.
Sometimes in the documentation, you may see both.
Emphysema trumps COPD and asthma.
Common medications used for COPD patients, youíll see these a lot.
Bronchodilators and inhalers and nebulizers.
Letís see, the corticosteroids, youíre going to see those a lot.
The theophylline, albuterol, atrovent, combientÖ you notice how the names all sound kind of
the same?
That Serevent, I see that.
Spiriva, thatís a new one.
You may have seen that one actually advertised on TV because itís a new one.
Prednisone, a lot of patients that areÖ that have difficulty in breathing are put on prednisone
because ultimately, itís an anti-inflammatory but it kind of dries out those tissues, as
well.
Often, your patients are going to be on O2 and generally, itís continuous O2.
So thatís one of the things you can look for in your documentation to confirm that
your patient has COPD.
There are some diagnostic tests that are performed.
The chest x-ray, of course, is going to be your most common.
CT scans of the lungs, these ABGs, arterial blood gasses and thatís usually what they
do is they go in at the wrist and feel and draw blood with a needle straight up and down.
Theyíre going to hit an artery, not a vein so then itís a little bit differently.
They want arterial blood because thatís the blood that has the most oxygen in it.
and they want to see how much oxygen or gasses are in the arterial blood.
Symptoms of COPD, youíve got hypoxia, shortness of breath, dyspnea, wheezing.
Thereís a persistent cough.
You often have sputum production, chest tightness and patients are tired.
This hypersomnolence, I think thatís always funny.
Itís being sleepy in the daytime and thatís very common for people that have breathing
problems.
One thing thatís not written here that is common, if youíve ever worked with people
that have COPD especially emphysema, theyíre very cranky.
Itís even documented sometimes where itíll talk about their anxiety and irritability
and stuff.
Thereís just something about not being able to breathe makes you a very cranky person.
So I just thought that was interesting to add in there.
When you do pulse ox's (pulse oximetry) and I know some of you may not be familiar with
that.
But if you ever go in the hospital and you see something taped to someoneís finger and
on children, sometimes, theyíll put it on the toe.
And now, in doctorís offices, when you walk in and they check your vitals, they just clip
you know, they just put this little snappy thing on your finger and it will show you
your pulse ox right away, the oxygen and actually your pulse.
If you are on room air and youíre at 95 or less, thatís not a good thing.
You want to be as close to 100 as you can get.
People on room air usually are not at 100.
Theyíre usually at 97, 98, sometimes, 99.
But you put oxygen on them and they jump up to 100.
And thatís what you want to see.
But if youíve got somebody that comes in with a pulse ox or you see it documented and
anything below 95, especially like 80ís and stuff like that.
That is somebody thatís in distress.
Youíll see that.
Thatíll be documented.
Those are some additional things to know about people with COPD, signs and symptoms to look
for when youíre coding.
As we scroll down just a little bit more, I think I have an example.
Oh physical exams, diminished breath sounds.
Now thisÖ when youíre looking at a report, these evaluations, this isÖ Laureen was saying
a minute ago about the E&M coding.
Each one of these things are things that are going to be listed in the physical exam.
Youíre going to see notated, diminished breath sounds, rhonchi, crackles, wheezing, and barrel
chest.
Thatís actually when the chest is kind of distended.
Pursed lips when breathing and youíd have to see it kind of to recognize it, I guess.
But purse your lips likeÖ not like youíre going to kiss but like youíre frustrated
or something and youíll see it.
Itís because theyíre struggling to get air in.
Active use of accessory muscles in the neck and youíll noticeÖ if youÖ this is something
you see in children when theyíre having problems breathing.
Youíll see their little necks flare out and their nostrilsÖ their nostrils are literally
flaring out.
You can hear them sucking in air if you can see me and trying to get that air in.
Another thing thatís not common knowledge, I think, unless youíve been reading a lot
of reports or you know something about COPDers but they get clubbing of the fingers.
And youíll see that noted.
What that is is their fingersÖ well, the best wayÖ go Google a picture or go on YouTube.
But it looks like the end of their fingers where their nail is, got hit by a hammer.
So itís smushed, itís fat.
And itís almost like a cartoon thing and so thatís a sign of people that arenít getting
good oxygen supply.
Itís really interesting.
So a doctor can walk in and physically just scan a person and almost tell if theyíre
having trouble breathing by their appearance, looking at their hands, seeing if their nostrils
are flaring.
They donít even have to listen.
They can almost see that.
On the CCO forum, we did hearÖ oh I guess itís a few weeks ago now.
There were some really neat YouTube videos with actual sounds of what it sounds like
to listen to a person that has rhonchi or the wheezing.
And I donít remember where I put it.
I may have put it in one of the specialty ones.
I didnít put the direct link on there.
I just direct them to the forum.
Laureen: Thatís okay.
Alicia: And it was interesting, really interesting.
Itís not, if I say rhonchi, you donít really know what that is until you hear it.
But once you hear it, youíll recognize it and youíll think about it when youíre coding.
ìOh he said rhonchi.
I know exactly what theyíre talking about.î So itís very important as a coder to understand
what these words mean because itís going to make you a better coder.
Itís going to help you pick up on the terms and the signs and symptoms that you need to
get the best possible code.
Laureen: Great.
Here you go.
You do love your diagnostic stuff, donít you, girl?
Alicia: Oh I do, I do, I do.
Laureen isÖ sheís the queen instructor and she is theÖ I guess you could say the queen
bee of CPT.
But I like diagnoses.