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Coding for acute bronchitis and comorbidity

The HEDIS® “Avoidance of Antibiotic Treatment” measure includes adults 18 to 64 years old who were diagnosed with uncomplicated acute bronchitis and who were not prescribed an antibiotic. However, as you know, a patient who has a co-morbid condition and/or bacterial infection may require treatment of acute bronchitis with an antibiotic. This makes it critical that you use proper coding when prescribing an antibiotic for these patients. Proper coding will ensure that these members are excluded from the “Avoidance of Antibiotic Treatment” measure. 

Use one of these codes to identify acute bronchitis: 

Description ICD-10-CM Diagnosis
Acute bronchitis J20.3, J20.4, J20.5, J20.6, J20.7, J20.8, J20.9

 

Make sure to add comdes to indentify co-morbid conditions, as applicable:

 
Bronchiectasis
Chronic airway obstruction, chronic obstructive asthma
Chronic bronchitis
Cystic fibrosis
Disorders of the immune system
Emphysema
Extrinsic allergic alveolitis
HIV disease; asymptomatic HIV
Malignancy neoplasms
Other diseases of the respiratory system
Pneumoconiosis and other lung disease due to external agents
Tuberculosis

 

Great resources on antibiotic utilization can be found on the CDC website from their GETSMART campaign. Visit cdc.gov/getsmart/campaign-materials/print-materials.html for more information. 

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