J45 - Asthma

Clinical Information

• Airway Remodeling-. the structural changes in the number, mass, size and/or composition of the airway tissues.
• Asthma-. a form of bronchial disorder with three distinct components: airway hyper-responsiveness (respiratory hypersensitivity), airway inflammation, and intermittent airway obstruction. it is characterized by spasmodic contraction of airway smooth muscle, wheezing, and dyspnea (dyspnea, paroxysmal).
• Asthma, Aspirin-Induced-. asthmatic adverse reaction (e.g., bronchoconstriction) to conventional nsaids including aspirin use.
• Asthma, Exercise-Induced-. asthma attacks following a period of exercise. usually the induced attack is short-lived and regresses spontaneously. the magnitude of postexertional airway obstruction is strongly influenced by the environment in which exercise is performed (i.e. inhalation of cold air during physical exertion markedly augments the severity of the airway obstruction; conversely, warm humid air blunts or abolishes it).
• Asthma, Occupational-. asthma attacks caused, triggered, or exacerbated by occupational exposure.
• Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome-. syndrome with clinical features of both asthma and copd.
• Conyza-. a plant genus of the family asteraceae. members contain alkenynes, daucosterol, friedelinol, conyzasaponins and other triterpenes.
• Dyspnea, Paroxysmal-. a disorder characterized by sudden attacks of respiratory distress in at rest patients with heart failure and pulmonary edema. it usually occurs at night after several hours of sleep in a reclining position. patients awaken with a feeling of suffocation, coughing, a cold sweat, and tachycardia. when there is significant wheezing, it is called cardiac asthma.
• Status Asthmaticus-. a sudden intense and continuous aggravation of a state of asthma, marked by dyspnea to the point of exhaustion and collapse and not responding to the usual therapeutic efforts.
• Tylophora-. a plant genus of the family asclepiadaceae. members contain phenanthro-indolizidine alkaloids.
• Occupational Exposure-. the exposure to potentially harmful chemical, physical, or biological agents that occurs as a result of one's occupation.

Specific Coding for Asthma

Non-specific codes like J45 require more digits to indicate the appropriate level of specificity. Consider using any of the following ICD-10 codes with a higher level of specificity when coding for asthma:

Patient Education

Asthma

What is asthma?

Asthma is a chronic (long-term) lung disease. It affects your airways, the tubes that carry air in and out of your lungs. When you have asthma, your airways can become inflamed and narrowed. This can cause wheezing, coughing, and tightness in your chest. When these symptoms get worse than usual, it is called an asthma attack or flare-up.

What causes asthma?

The exact cause of asthma is unknown. Genetics and your environment likely play a role in who gets asthma.

An asthma attack can happen when you are exposed to an asthma trigger. An asthma trigger is something that can set off or worsen your asthma symptoms. Different triggers can cause different types of asthma:

• Allergic asthma is caused by allergens. Allergens are substances that cause an allergic reaction. They can include
  • Dust mites
  • Mold
  • Pets
  • Pollen from grass, trees, and weeds
  • Waste from pests such as cockroaches and mice
• Nonallergic asthma is caused by triggers that are not allergens, such as
  • Breathing in cold air
  • Certain medicines
  • Household chemicals
  • Infections such as colds and the flu
  • Outdoor air pollution
  • Tobacco smoke
• Occupational asthma is caused by breathing in chemicals or industrial dusts at work
• Exercise-induced asthma happens during physical exercise, especially when the air is dry

Asthma triggers may be different for each person and can change over time.

Who is at risk for asthma?

Asthma affects people of all ages, but it often starts during childhood. Certain factors can raise your risk of having asthma:

• Being exposed to secondhand smoke when your mother is pregnant with you or when you are a small child
• Being exposed to certain substances at work, such as chemical irritants or industrial dusts
• Genetics and family history. You are more likely to have asthma if one of your parents has it, especially if it's your mother.
• Race or ethnicity. Black and African Americans and Puerto Ricans are at higher risk of asthma than people of other races or ethnicities.
• Having other diseases or conditions such as obesity and allergies
• Often having viral respiratory infections as a young child
• Sex. In children, asthma is more common in boys. In teens and adults, it is more common in women.

What are the symptoms of asthma?

The symptoms of asthma include:

• Chest tightness
• Coughing, especially at night or early morning
• Shortness of breath
• Wheezing, which causes a whistling sound when you breathe out

These symptoms can range from mild to severe. You may have them every day or only once in a while.

When you are having an asthma attack, your symptoms get much worse. The attacks may come on gradually or suddenly. Sometimes they can be life-threatening. They are more common in people who have severe asthma. If you are having asthma attacks, you may need a change in your treatment.

How is asthma diagnosed?

Your health care provider may use many tools to diagnose asthma:

• Physical exam
• Medical history
• Lung function tests, including spirometry, to test how well your lungs work
• Tests to measure how your airways react to specific exposures. During this test, you inhale different concentrations of allergens or medicines that may tighten the muscles in your airways. Spirometry is done before and after the test.
• Peak expiratory flow (PEF) tests to measure how fast you can blow air out using maximum effort
• Fractional exhaled nitric oxide (FeNO) tests to measure levels of nitric oxide in your breath when you breathe out. High levels of nitric oxide may mean that your lungs are inflamed.
• Allergy skin or blood tests, if you have a history of allergies. These tests check which allergens cause a reaction from your immune system.

What are the treatments for asthma?

If you have asthma, you will work with your health care provider to create a treatment plan. The plan will include ways to manage your asthma symptoms and prevent asthma attacks. It will include:

• Strategies to avoid triggers. For example, if tobacco smoke is a trigger for you, you should not smoke or allow other people to smoke in your home or car.
• Short-term relief medicines, also called quick-relief medicines. They help prevent symptoms or relieve symptoms during an asthma attack. They include an inhaler to carry with you all the time. It may also include other types of medicines which work quickly to help open your airways.
• Control medicines. You take them every day to help prevent symptoms. They work by reducing airway inflammation and preventing narrowing of the airways.

If you have a severe attack and the short-term relief medicines do not work, you will need emergency care.

Your provider may adjust your treatment until asthma symptoms are controlled.

Sometimes asthma is severe and cannot be controlled with other treatments. If you are an adult with uncontrolled asthma, in some cases your provider might suggest bronchial thermoplasty. This is a procedure that uses heat to shrink the smooth muscle in the lungs. Shrinking the muscle reduces your airway's ability to tighten and allows you to breathe more easily. The procedure has some risks, so it's important to discuss them with your provider.

Allergic asthma

Asthma is a breathing disorder characterized by inflammation of the airways and recurrent episodes of breathing difficulty. These episodes, sometimes referred to as asthma attacks, are triggered by irritation of the inflamed airways. In allergic asthma, the attacks occur when substances known as allergens are inhaled, causing an allergic reaction. Allergens are harmless substances that the body's immune system mistakenly reacts to as though they are harmful. Common allergens include pollen, dust, animal dander, and mold. The immune response leads to the symptoms of asthma. Allergic asthma is the most common form of the disorder.

A hallmark of asthma is bronchial hyperresponsiveness, which means the airways are especially sensitive to irritants and respond excessively. Because of this hyperresponsiveness, attacks can be triggered by irritants other than allergens, such as physical activity, respiratory infections, or exposure to tobacco smoke, in people with allergic asthma.

An asthma attack is characterized by tightening of the muscles around the airways (bronchoconstriction), which narrows the airway and makes breathing difficult. Additionally, the immune reaction can lead to swelling of the airways and overproduction of mucus. During an attack, an affected individual can experience chest tightness, wheezing, shortness of breath, and coughing. Over time, the muscles around the airways can become enlarged (hypertrophied), further narrowing the airways.

Some people with allergic asthma have another allergic disorder, such as hay fever (allergic rhinitis) or food allergies. Asthma is sometimes part of a series of allergic disorders, referred to as the atopic march. Development of these conditions typically follows a pattern, beginning with eczema (atopic dermatitis), followed by food allergies, then hay fever, and finally asthma. However, not all individuals with asthma have progressed through the atopic march, and not all individuals with one allergic disease will develop others.

Code History

• FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
• FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
• FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
• FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
• FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
• FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
• FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
• FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016 (First year ICD-10-CM implemented into the HIPAA code set)