Skip to Content

Provider Manual

Risk Adjustment - Pulmonary disease

Last Updated on June 17, 2019

Hierarchical Condition Category Coding and Pulmonary Disease

There are several pulmonary conditions associated with Hierarchical Condition Category codes.  Conditions that fall within the ICD10 Chronic Obstructive Pulmonary Disease (COPD) or fibrosis of the lung and other chronic lung disorders code set include the following;

  • Chronic  obstructive pulmonary disease
    • COPD with acute lower respiratory infection
    • COPD with acute exacerbation,
    • Chronic asthmatic (obstructive) bronchitis  
    • Chronic bronchitis with airways obstruction  
    • Chronic bronchitis with emphysema  
    • Chronic emphysematous bronchitis  
    • Chronic obstructive tracheobronchitis 
  • Chronic obstructive asthma,
  • Chronic bronchitis
    • Simple chronic bronchitis
    • Mucopurulent chronic bronchitis
    • Mixed simple and mucopurulent chronic bronchitis
    • Chronic tracheitis
    • Chronic tracheobronchitis
  • Emphysema
    • Emphysematous bleb
    • Unilateral pulmonary emphysema
    • Panlobular emphysema
    • Centrilobular emphysema
    • Bullous emphysema
    • Vesicular emphysema
  • Chronic obstructive asthma
  • Bronchiectasis
    • With acute exacerbation
    • With acute lower respiratory infection
    • Uncomplicated
In patients with pulmonary disease, also document, diagnose and code the following when present:
  • Hypoxemia
  • Hypercapnia
  • Acute respiratory failure
  • Chronic respiratory failure
  • Tracheostomy status
  • Oxygen dependence – be sure to document the reason for the oxygen
  • Respirator or ventilator dependence
  • Pneumonia – document and diagnose the type of pneumonia and causative organism, when known

Questions

Brenda Anderson
Revenue Management Educator
Security Health Plan 
Telephone: 715-221-9598

Shared email:   rf.shp.risk.adjustmnt@securityhealth.org