ICD-9 Code 491.22

Obstructive chronic bronchitis with acute bronchitis

Not Valid for Submission

491.22 is a legacy non-billable code used to specify a medical diagnosis of obstructive chronic bronchitis with acute bronchitis. This code was replaced on September 30, 2015 by its ICD-10 equivalent.

ICD-9: 491.22
Short Description:Obs chr bronc w ac bronc
Long Description:Obstructive chronic bronchitis with acute bronchitis

Convert 491.22 to ICD-10

The following crosswalk between ICD-9 to ICD-10 is based based on the General Equivalence Mappings (GEMS) information:

  • J44.0 - Chr obstructive pulmon disease with (acute) lower resp infct

Code Classification

  • Diseases of the respiratory system (460–519)
    • Chronic obstructive pulmonary disease and allied conditions (490-496)
      • 491 Chronic bronchitis

Information for Medical Professionals

Index to Diseases and Injuries

References found for the code 491.22 in the Index of Diseases and Injuries:


Information for Patients


COPD

What is COPD (chronic obstructive pulmonary disease)?

COPD (chronic obstructive pulmonary disease) is a group of lung diseases that make it hard to breathe and get worse over time.

Normally, the airways and air sacs in your lungs are elastic or stretchy. When you breathe in, the airways bring air to the air sacs. The air sacs fill up with air, like a small balloon. When you breathe out, the air sacs deflate, and the air goes out. If you have COPD, less air flows in and out of your airways because of one or more problems:

  • The airways and air sacs in your lungs become less elastic
  • The walls between many of the air sacs are destroyed
  • The walls of the airways become thick and inflamed
  • The airways make more mucus than usual and can become clogged

What are the types of COPD (chronic obstructive pulmonary disease)?

COPD includes two main types:

  • Emphysema affects the air sacs in your lungs, as well as the walls between them. They become damaged and are less elastic.
  • Chronic bronchitis, in which the lining of your airways is constantly irritated and inflamed. This causes the lining to swell and make mucus.

Most people with COPD have both emphysema and chronic bronchitis, but how severe each type is can be different from person to person.

What causes COPD (chronic obstructive pulmonary disease)?

The cause of COPD is usually long-term exposure to irritants that damage your lungs and airways. In the United States, cigarette smoke is the main cause. Pipe, cigar, and other types of tobacco smoke can also cause COPD, especially if you inhale them.

Exposure to other inhaled irritants can contribute to COPD. These include secondhand smoke, air pollution, and chemical fumes or dusts from the environment or workplace.

Rarely, a genetic condition called alpha-1 antitrypsin deficiency can play a role in causing COPD.

Who is at risk for COPD (chronic obstructive pulmonary disease)?

The risk factors for COPD include:

  • Smoking. This the main risk factor. Up to 75% of people who have COPD smoke or used to smoke.
  • Long-term exposure to other lung irritants, such as secondhand smoke, air pollution, and chemical fumes and dusts from the environment or workplace
  • Age. Most people who have COPD are at least 40 years old when their symptoms begin.
  • Genetics. This includes alpha-1 antitrypsin deficiency, which is a genetic condition. Also, smokers who get COPD are more likely to get it if they have a family history of COPD.
  • Asthma. People who have asthma have more risk of developing COPD than people who don't have asthma. But most people with asthma will not get COPD.

What are the symptoms of COPD (chronic obstructive pulmonary disease)?

At first, you may have no symptoms or only mild symptoms. As the disease gets worse, your symptoms usually become more severe. They can include:

  • Frequent coughing or a cough that produces a lot mucus
  • Wheezing
  • A whistling or squeaky sound when you breathe
  • Shortness of breath, especially with physical activity
  • Tightness in your chest

Some people with COPD get frequent respiratory infections such as colds and the flu. In severe cases, COPD can cause weight loss, weakness in your lower muscles, and swelling in your ankles, feet, or legs.

How is COPD (chronic obstructive pulmonary disease) diagnosed?

Your health care provider may use many tools to make a diagnosis:

  • A medical history, which includes asking about your symptoms
  • A family history
  • Various tests, such as lung function tests, a chest x-ray or CT scan, and blood tests

Your doctor will diagnose COPD based on your signs and symptoms, your medical and family histories, and test results.

What are the treatments for COPD (chronic obstructive pulmonary disease)?

There is no cure for COPD. However, treatments can help with symptoms, slow the progress of the disease, and improve your ability to stay active. There are also treatments to prevent or treat complications of the disease. Treatments include:

  • Lifestyle changes, such as
    • Quitting smoking if you are a smoker. This is the most important step you can take to treat COPD.
    • Avoiding secondhand smoke and places where you might breathe in other lung irritants
    • Ask your health care provider for an eating plan that will meet your nutritional needs. Also ask about how much physical activity you can do. Physical activity can strengthen the muscles that help you breathe and improve your overall wellness.
  • Medicines, such as
    • Bronchodilators, which relax the muscles around your airways. This helps open your airways and makes breathing easier. Most bronchodilators are taken through an inhaler. In more severe cases, the inhaler may also contain steroids to reduce inflammation.
    • Vaccines for the flu and pneumococcal pneumonia, since people with COPD are at higher risk for serious problems from these diseases
    • Antibiotics if you get a bacterial or viral lung infection
  • Oxygen therapy, if you have severe COPD and low levels of oxygen in your blood. Oxygen therapy can help you breathe better. You may need extra oxygen all the time or only at certain times.
  • Pulmonary rehabilitation, which is a program that helps improve the well-being of people who have chronic breathing problems. It may include
    • An exercise program
    • Disease management training
    • Nutritional counseling
    • Psychological counseling
  • Surgery, usually as a last resort for people who have severe symptoms that have not gotten better with medicines:
    • For COPD that is mainly related to emphysema, there are surgeries that
      • Remove damaged lung tissue
      • Remove large air spaces (bullae) that can form when air sacs are destroyed. The bullae can interfere with breathing.
    • For severe COPD, some people may need lung transplant

If you have COPD, it's important to know when and where to get help for your symptoms. You should get emergency care if you have severe symptoms, such as trouble catching your breath or talking. Call your health care provider if your symptoms are getting worse or if you have signs of an infection, such as a fever.

Can COPD (chronic obstructive pulmonary disease) be prevented?

Since smoking causes most cases of COPD, the best way to prevent it is to not smoke. It's also important to try to avoid lung irritants such as secondhand smoke, air pollution, chemical fumes, and dusts.

NIH: National Heart, Lung, and Blood Institute


[Read More]

Chronic Bronchitis

What is chronic bronchitis?

Chronic bronchitis is a type of COPD (chronic obstructive pulmonary disease). COPD is a group of lung diseases that make it hard to breathe and get worse over time. The other main type of COPD is emphysema. Most people with COPD have both emphysema and chronic bronchitis, but how severe each type is can be different from person to person.

Chronic bronchitis is inflammation (swelling) and irritation of the bronchial tubes. These tubes are the airways that carry air to and from the air sacs in your lungs. The irritation of the tubes causes mucus to build up. This mucus and the swelling of the tubes make it harder for your lungs to move oxygen in and carbon dioxide out of your body.

What causes chronic bronchitis?

The cause of chronic bronchitis is usually long-term exposure to irritants that damage your lungs and airways. In the United States, cigarette smoke is the main cause. Pipe, cigar, and other types of tobacco smoke can also cause chronic bronchitis, especially if you inhale them.

Exposure to other inhaled irritants can contribute to chronic bronchitis. These include secondhand smoke, air pollution, and chemical fumes or dusts from the environment or workplace.

Rarely, a genetic condition called alpha-1 antitrypsin deficiency can play a role in causing chronic bronchitis.

Who is at risk for chronic bronchitis?

The risk factors for chronic bronchitis include:

  • Smoking. This the main risk factor. Up to 75% of people who have chronic bronchitis smoke or used to smoke.
  • Long-term exposure to other lung irritants, such as secondhand smoke, air pollution, and chemical fumes and dusts from the environment or workplace.
  • Age. Most people who have chronic bronchitis are at least 40 years old when their symptoms begin.
  • Genetics. This includes alpha-1 antitrypsin deficiency, which is a genetic condition. Also, smokers who get chronic bronchitis are more likely to get it if they have a family history of COPD.

What are the symptoms of chronic bronchitis?

At first, you may have no symptoms or only mild symptoms. As the disease gets worse, your symptoms usually become more severe. They can include:

  • Frequent coughing or a cough that produces a lot mucus
  • Wheezing
  • A whistling or squeaky sound when you breathe
  • Shortness of breath, especially with physical activity
  • Tightness in your chest

Some people with chronic bronchitis get frequent respiratory infections such as colds and the flu. In severe cases, chronic bronchitis can cause weight loss, weakness in your lower muscles, and swelling in your ankles, feet, or legs.

How is chronic bronchitis diagnosed?

Your health care provider may use many tools to make a diagnosis:

  • A medical history, which includes asking about your symptoms
  • A family history
  • Various tests, such as lung function tests, a chest x-ray or CT scan, and blood tests

What are the treatments for chronic bronchitis?

There is no cure for chronic bronchitis. However, treatments can help with symptoms, slow the progress of the disease, and improve your ability to stay active. There are also treatments to prevent or treat complications of the disease. Treatments include:

  • Lifestyle changes, such as
    • Quitting smoking if you are a smoker. This is the most important step you can take to treat chronic bronchitis.
    • Avoiding secondhand smoke and places where you might breathe in other lung irritants
    • Ask your health care provider for an eating plan that will meet your nutritional needs. Also ask about how much physical activity you can do. Physical activity can strengthen the muscles that help you breathe and improve your overall wellness.
  • Medicines, such as
    • Bronchodilators, which relax the muscles around your airways. This helps open your airways and makes breathing easier. Most bronchodilators are taken through an inhaler. In more severe cases, the inhaler may also contain steroids to reduce inflammation.
    • Vaccines for the flu and pneumococcal pneumonia, since people with chronic bronchitis are at higher risk for serious problems from these diseases.
    • Antibiotics if you get a bacterial or viral lung infection
  • Oxygen therapy, if you have severe chronic bronchitis and low levels of oxygen in your blood. Oxygen therapy can help you breathe better. You may need extra oxygen all the time or only at certain times.
  • Pulmonary rehabilitation, which is a program that helps improve the well-being of people who have chronic breathing problems. It may include
    • An exercise program
    • Disease management training
    • Nutritional counseling
    • Psychological counseling
  • A lung transplant, as a last resort for people who have severe symptoms that have not gotten better with medicines

If you have chronic bronchitis, it's important to know when and where to get help for your symptoms. You should get emergency care if you have severe symptoms, such as trouble catching your breath or talking. Call your health care provider if your symptoms are getting worse or if you have signs of an infection, such as a fever.

Can chronic bronchitis be prevented?

Since smoking causes most cases of chronic bronchitis, the best way to prevent it is to not smoke. It's also important to try to avoid lung irritants such as secondhand smoke, air pollution, chemical fumes, and dusts.

NIH: National Heart, Lung, and Blood Institute


[Read More]

ICD-9 Footnotes

General Equivalence Map Definitions
The ICD-9 and ICD-10 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.

  • Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
  • No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
  • Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system.

Index of Diseases and Injuries Definitions

  • And - The word "and" should be interpreted to mean either "and" or "or" when it appears in a title.
  • Code also note - A "code also" note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction.
  • Code first - Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
  • Type 1 Excludes Notes - A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
  • Type 2 Excludes Notes - A type 2 Excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
  • Includes Notes - This note appears immediately under a three character code title to further define, or give examples of, the content of the category.
  • Inclusion terms - List of terms is included under some codes. These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
  • NEC "Not elsewhere classifiable" - This abbreviation in the Alphabetic Index represents "other specified". When a specific code is not available for a condition, the Alphabetic Index directs the coder to the "other specified” code in the Tabular List.
  • NOS "Not otherwise specified" - This abbreviation is the equivalent of unspecified.
  • See - The "see" instruction following a main term in the Alphabetic Index indicates that another term should be referenced. It is necessary to go to the main term referenced with the "see" note to locate the correct code.
  • See Also - A "see also" instruction following a main term in the Alphabetic Index instructs that there is another main term that may also be referenced that may provide additional Alphabetic Index entries that may be useful. It is not necessary to follow the "see also" note when the original main term provides the necessary code.
  • 7th Characters - Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters.
  • With - The word "with" should be interpreted to mean "associated with" or "due to" when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The word "with" in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order.