ICD-10 codes for asthma are based on the severity of the condition, such as mild intermittent, mild persistent, moderate persistent.

1. Documenting and
Coding
Asthma in ICD-10
ICD-10 codes for asthma
are based on the severity
of the condition, such as
mild intermittent, mild
persistent, moderate
persistent.
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2. Asthma is a chronic lung disease that inflames and narrows the airways in the lungs and can
make breathing difficult and trigger coughing, wheezing and shortness of breath. Allergic asthma
can be life-threatening. According to the American Academy of Allergy Asthma and Immunology,
one in 12 people (about 25 million, or 8% of the U.S. population) had asthma in 2009, compared
with 1 in 14 (about 20 million, or 7%) in 2001. An allergist / immunologist diagnosing and
treating asthma should document it for further reference and for reimbursement purposes. They
can also rely on medical coding outsourcing to meet the complex coding tasks
The ICD-10 code set combines both intrinsic and extrinsic into one category, making it easier for
coders to look for documentation. In ICD-10, asthma is coded in as intermittent or persistent,
adding mild - moderate - severe as descriptors, just as physicians would describe patients. The
following conditions should be included while documenting asthma:
• Cause: Exercise-induced, cough variant, related to smoking, chemical or particular cause,
occupational
• Severity: For persistent asthma patients, one of the following options should be used:
- Mild persistent
- Moderate persistent
- Severe persistent
• Temporal Factors: Acute, chronic, intermittent, persistent, status asthmaticus, acute
exacerbation
Category
Differentiated by temporal factors, mild asthma has two appropriate categories, such as
• J45.2 Mild intermittent asthma
• J45.3 Mild persistent asthma
Moderate and severe asthma
• J45.4 Moderate persistent asthma
• J45.5 Severe persistent asthma
If the condition cannot be identified as mild, moderate or severe, it can be coded as
• J45.99 Other asthma
Or
• J45.90 Unspecified asthma
The ‘other asthma’ category has three unique options: exercise induced bronchospasm, cough
variant asthma, and other asthma.
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3. Three further sub-categories are - uncomplicated, with acute exacerbation and status
asthmaticus.
Uncomplicated
• J45.20 Mild intermittent asthma, uncomplicated
• J45.50 Severe persistent asthma, uncomplicated
• J45.909 Unspecified asthma, uncomplicated
Acute exacerbation
• J45.21 Mild intermittent asthma with (acute) exacerbation
• J45.31 Mild persistent asthma with (acute) exacerbation
• J45.41 Moderate persistent asthma with (acute) exacerbation
• J45.51 Severe persistent asthma with (acute) exacerbation
• J45.901 Unspecified asthma with (acute) exacerbation
Status asthmaticus
• J45.22 Mild intermittent asthma with status asthmaticus
• J45.32 Mild persistent asthma with status asthmaticus
• J45.42 Moderate persistent asthma with status asthmaticus
• J45.52 Severe persistent asthma with status asthmaticus
• J45.902 Unspecified asthma with status asthmaticus
Causes
While the main cause of asthma is smoking, other risk factors include having allergic conditions,
family history of allergies or asthma, being overweight, and exposure to second hand smoke and
occupational triggers. Documenting the cause of the condition requires using other common
codes such as
• Z77.22 Contact with and (suspected) exposure to environmental tobacco smoke (acute)
(chronic)
• P96.81 Exposure to (parental) (environmental) tobacco smoke in the perinatal period
• Z87.891 Personal history of nicotine dependence
• Z57.31 Occupational exposure to environmental tobacco smoke
• F17.228 Nicotine dependence, chewing tobacco, with other nicotine-induced disorders
• F17.298 Nicotine dependence, other tobacco product, with other nicotine-induced
disorders
• Z72.0 Tobacco use
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4. Coders at hospitals and medical coding companies must also be aware of other exceptions from
a diagnosis as J45 asthma, such as
• J67.8 Hypersensitivity pneumonitis due to other organic dusts (wood asthma)
• J69.8 Pneumonitis due to inhalation of other solids and liquids (detergent asthma)
• J82 Pulmonary eosinophilia, not elsewhere classified (eosinophilic asthma)
• J60 Coal worker's pneumoconiosis (miner's asthma)
• R06.2 Wheezing
These types of asthma cannot be combined with a J45 code because the conditions cannot
coexist. However, chronic obstructive asthma (J44.9) can be included in the submitted code
because the condition can coexist with a J45 code. A clear understanding of the structure and
organization of ICD-10 is critical to code this condition that comes with a wide variety of
potential choices.
Several studies also exist that links between asthma in women and changes in levels of
female hormones such as estrogen and progesterone. Let us discuss this topic in our next
blog.
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