ICD-10 Guide

J43.2

Centrilobular emphysema

BILLABLE STATUSYes

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/06/2025

Code Description

ICD-10 J43.2 is a billable code used to indicate a diagnosis of centrilobular emphysema.

Key Diagnostic Point:

Centrilobular emphysema is a form of chronic obstructive pulmonary disease (COPD) characterized by the destruction of the central portions of the acini, which are the functional units of the lung. This condition primarily affects the upper lobes and is often associated with long-term exposure to irritants such as tobacco smoke and environmental pollutants. Clinically, patients may present with symptoms such as chronic cough, sputum production, and progressive dyspnea, particularly during exertion. As the disease progresses, patients may experience increased respiratory distress and reduced exercise tolerance. Diagnostic considerations include pulmonary function tests (PFTs) that reveal airflow limitation, imaging studies such as chest X-rays or CT scans that show hyperinflation and structural changes in the lungs, and a thorough patient history to assess risk factors. Early diagnosis and management are crucial to slow disease progression and improve quality of life.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Diagnostic complexity: Requires comprehensive pulmonary function testing and imaging.
Treatment complexity: Management may involve bronchodilators, corticosteroids, and lifestyle modifications.
Documentation requirements: Detailed clinical history and symptom assessment are necessary.
Coding specificity: Requires accurate identification of centrilobular emphysema versus other forms of emphysema.

Audit Risk Factors

Common coding errors: Misclassification of emphysema type.
Documentation gaps: Incomplete patient history or symptom description.
Billing challenges: Potential denials due to insufficient documentation of chronicity or severity.

Specialty Focus

Medical Specialties

Pulmonology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Primary Care

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Centrilobular emphysema significantly impacts population health, particularly in regions with high smoking rates and air pollution. It contributes to increased healthcare utilization, including frequent hospitalizations and outpatient visits for exacerbations. Quality measures focus on smoking cessation programs and management of COPD symptoms to improve patient outcomes. Epidemiologically, the prevalence of centrilobular emphysema is rising, necessitating targeted public health interventions to reduce risk factors and improve lung health.

ICD-9 vs ICD-10

Reimbursement & Billing Impact

impact on daily activities. Reimbursement considerations include the need for thorough documentation of the diagnosis and treatment plan, as well as adherence to payer-specific guidelines. Common denials may arise from insufficient documentation of the chronic nature of the condition or lack of evidence supporting the necessity of prescribed therapies. Best practices include maintaining clear and detailed records of patient interactions and treatment responses.

Resources

Clinical References

•
ICD-10 Official Guidelines for J00-J99
•
Clinical Documentation Requirements

Coding & Billing References

•
ICD-10 Official Guidelines for J00-J99
•
Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by J43.2?

J43.2 specifically covers centrilobular emphysema, which is primarily associated with smoking and environmental exposures. It is characterized by damage to the central parts of the acini, leading to airflow obstruction.

When should J43.2 be used instead of related codes?

J43.2 should be used when the clinical presentation and diagnostic findings specifically indicate centrilobular emphysema, distinguishing it from other types of emphysema such as panlobular or paraseptal emphysema.

What documentation supports J43.2?

Documentation should include a detailed patient history, results from pulmonary function tests indicating airflow limitation, imaging studies showing characteristic lung changes, and a clear assessment of risk factors.

ICD-10 J43.2 is a billable code used to indicate a diagnosis of centrilobular emphysema.