2025 ICD-10-CM code J43.8
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Respiratory Diseases - Chronic lower respiratory diseases Diseases of the respiratory system Feed
Other emphysema is a chronic lung condition characterized by the abnormal enlargement of air spaces in the lungs, leading to shortness of breath and cough.
Modifiers might be applicable based on the circumstances of service, such as the place of service or the type of provider involved.Consult official modifier guidelines.
Medical necessity for coding J43.8 is established through clinical documentation supporting the diagnosis of emphysema, including symptoms, physical examination findings, and objective evidence of airflow limitation and lung damage on pulmonary function tests or imaging studies.Treatment plans should be medically appropriate given the severity of the disease.
The clinical responsibility for patients with J43.8 would involve a pulmonologist or other qualified physician specializing in respiratory medicine.Responsibilities would encompass diagnosis, management of symptoms (including medication, respiratory therapy, and potentially pulmonary rehabilitation), and ongoing monitoring of the patient's condition.In some cases, other specialists might be involved, such as surgeons for more severe cases.
In simple words: Other emphysema is a lung disease where the tiny air sacs in your lungs get damaged and lose their shape. This makes it hard to breathe and can cause a persistent cough.Smoking is a major cause, but other things like genetics and pollution can also play a role.
J43.8, Other emphysema, in the ICD-10-CM classification, encompasses various forms of emphysema not specifically categorized elsewhere.It refers to a chronic obstructive pulmonary disease (COPD) characterized by the destruction of alveolar walls in the lungs, resulting in abnormal enlargement of air spaces. This leads to reduced lung elasticity, airflow limitation, and impaired gas exchange.Clinical manifestations commonly include dyspnea (shortness of breath), chronic cough, and wheezing.Etiology often involves long-term exposure to irritants, most notably cigarette smoke.Other contributing factors may include genetic predisposition (alpha-1 antitrypsin deficiency) and environmental pollutants.
Example 1: A 65-year-old male with a 40-pack-year smoking history presents with progressive dyspnea on exertion and a chronic cough.Spirometry reveals evidence of airflow limitation consistent with COPD, and a chest CT scan demonstrates panacinar emphysema.The physician codes J43.8, Other emphysema, along with Z72.0 (Tobacco use)., A 70-year-old female with alpha-1 antitrypsin deficiency develops symptoms of emphysema, including shortness of breath and a chronic cough. Pulmonary function tests confirm the diagnosis, and a chest CT scan shows bullous emphysema.The physician codes J43.8, Other emphysema, in conjunction with E84.1 (Alpha-1 antitrypsin deficiency)., A 50-year-old coal miner presents with chronic cough, dyspnea, and decreased lung function. Imaging studies reveal diffuse emphysema along with evidence of coal worker's pneumoconiosis. The physician codes J43.8 (Other emphysema) and J65.8 (Other specified pneumoconioses).
Detailed history and physical examination, including smoking history and family history of lung disease; spirometry results demonstrating airflow obstruction; chest imaging (CT scan or chest x-ray); and other relevant laboratory or diagnostic studies to rule out alternative diagnoses.
** Accurate documentation is critical for proper coding and reimbursement.Ensure consistent use of clinical terminology.Always refer to the most current ICD-10-CM guidelines for proper coding practices.
- Revenue Code: Depending on the services provided, various revenue codes might apply.Examples could include codes related to evaluation and management, respiratory therapy, or pulmonary rehabilitation.
- RVU: RVUs will vary depending on the specific services rendered and the location of service (facility vs. non-facility). Consult the appropriate fee schedule for determination.
- Global Days: Not applicable for this diagnosis code.
- Payment Status: Active
- Modifier TC rule: Not applicable; this is a diagnosis code, not a procedure code.
- Fee Schedule: Fee schedules for diagnosis codes (like J43.8) are not usually defined as they do not directly reflect procedures. Payment would be tied to related services provided (e.g., evaluation and management, tests).
- Specialties:Pulmonology, Internal Medicine, Respiratory Therapy
- Place of Service:Office, Hospital (Inpatient or Outpatient),Home Healthcare, Skilled Nursing Facility