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ICD-10 Guide
ICD-10 CodesJ45.3

J45.3

Mild persistent asthma

BILLABLE STATUSNo
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 J45.3 is a used to indicate a diagnosis of mild persistent asthma.

Key Diagnostic Point:

Mild persistent asthma is characterized by symptoms occurring more than twice a week but less than once daily. Patients may experience nighttime symptoms more than twice a month, and their lung function is typically normal between exacerbations. The condition primarily affects the bronchial tubes, which become inflamed and narrowed, leading to difficulty in breathing. The pathophysiology involves airway hyperresponsiveness, inflammation, and obstruction, which can be triggered by allergens, respiratory infections, exercise, and environmental factors. Diagnosis is based on clinical history, physical examination, and spirometry, which measures lung function. The disease can progress if not managed properly, leading to increased frequency and severity of symptoms. Regular monitoring and management are essential to prevent exacerbations and maintain control over symptoms. Treatment often includes inhaled corticosteroids and bronchodilators, with a focus on patient education regarding trigger avoidance and self-management strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough assessment of symptoms and triggers.
  • Treatment complexity: Involves ongoing management and potential adjustments in therapy.
  • Documentation requirements: Detailed records of symptoms, treatment response, and patient education are necessary.
  • Coding specificity: Requires accurate coding based on the severity and frequency of symptoms.

Audit Risk Factors

  • Common coding errors: Misclassification of asthma severity.
  • Documentation gaps: Incomplete records of symptom frequency and treatment response.
  • Billing challenges: Potential denials due to insufficient documentation of medical necessity.

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

Allergy and Immunology

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Mild persistent asthma affects a significant portion of the population, contributing to healthcare utilization through outpatient visits and medication prescriptions. Effective management is crucial for improving quality of life and reducing the risk of exacerbations. Population health initiatives focus on education and self-management strategies to enhance patient outcomes and minimize emergency room visits. Epidemiologically, understanding the prevalence and triggers of mild persistent asthma can inform public health strategies aimed at reducing the burden of respiratory diseases.

ICD-9 vs ICD-10

Mild persistent asthma affects a significant portion of the population, contributing to healthcare utilization through outpatient visits and medication prescriptions. Effective management is crucial for improving quality of life and reducing the risk of exacerbations. Population health initiatives focus on education and self-management strategies to enhance patient outcomes and minimize emergency room visits. Epidemiologically, understanding the prevalence and triggers of mild persistent asthma can inform public health strategies aimed at reducing the burden of respiratory diseases.

Reimbursement & Billing Impact

Reimbursement considerations include the need for thorough documentation to support the medical necessity of prescribed treatments, such as inhaled corticosteroids and bronchodilators. Common denials may arise from insufficient documentation of symptom frequency or treatment response. Best practices include maintaining clear records of patient interactions, treatment adjustments, and follow-up visits to ensure compliance with payer requirements and to facilitate smooth billing processes.

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 J45.3?

J45.3 covers mild persistent asthma, which includes patients experiencing symptoms more than twice a week but less than daily, with nighttime symptoms occurring more than twice a month. It does not include patients with moderate or severe persistent asthma.

When should J45.3 be used instead of related codes?

J45.3 should be used when a patient exhibits mild persistent asthma symptoms. It is important to differentiate it from J45.2 (Moderate persistent asthma) and J45.4 (Severe persistent asthma) based on the frequency and severity of symptoms.

What documentation supports J45.3?

Documentation should include a detailed history of symptoms, frequency of exacerbations, response to treatment, and any relevant spirometry results. It is crucial to note any triggers and the patient's management plan.