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v1.0.0
ICD-10 Guide
ICD-10 CodesJ45.90

J45.90

Unspecified asthma

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

Code Description

ICD-10 J45.90 is a used to indicate a diagnosis of unspecified asthma.

Key Diagnostic Point:

Unspecified asthma (ICD-10 code J45.90) refers to a condition characterized by chronic inflammation of the airways, leading to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. The respiratory system, particularly the bronchi and bronchioles, is primarily affected, resulting in airflow obstruction. Asthma can vary in severity and may be triggered by allergens, respiratory infections, exercise, or environmental factors. The disease progression can lead to increased airway hyperresponsiveness and chronic airway remodeling if not managed appropriately. Diagnostic considerations include a thorough patient history, physical examination, and pulmonary function tests, such as spirometry, to assess airflow limitation. J45.90 is used when the specific type of asthma is not documented, making it essential for healthcare providers to ensure accurate diagnosis and management to avoid complications and improve patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Asthma can present variably, requiring careful assessment to differentiate from other respiratory conditions.
  • Treatment complexity: Management may involve inhaled corticosteroids, bronchodilators, and lifestyle modifications, necessitating ongoing evaluation.
  • Documentation requirements: Accurate documentation of symptoms, triggers, and treatment response is crucial for appropriate coding.
  • Coding specificity: J45.90 is less specific than other asthma codes, which may lead to challenges in capturing the full clinical picture.

Audit Risk Factors

  • Common coding errors: Misuse of unspecified codes can lead to claim denials.
  • Documentation gaps: Incomplete patient records may result in inappropriate coding.
  • Billing challenges: Lack of specificity can complicate reimbursement and lead to audits.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Asthma significantly impacts population health, affecting millions globally and leading to increased healthcare utilization, including emergency visits and hospitalizations. Quality measures often focus on asthma control and management, emphasizing the importance of proper coding to reflect the severity and treatment of the condition. Epidemiologically, asthma prevalence varies by age, gender, and environmental factors, highlighting the need for targeted interventions and public health strategies to improve outcomes.

ICD-9 vs ICD-10

Asthma significantly impacts population health, affecting millions globally and leading to increased healthcare utilization, including emergency visits and hospitalizations. Quality measures often focus on asthma control and management, emphasizing the importance of proper coding to reflect the severity and treatment of the condition. Epidemiologically, asthma prevalence varies by age, gender, and environmental factors, highlighting the need for targeted interventions and public health strategies to improve outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the documentation supports the medical necessity of the services provided. Common denials may arise from insufficient documentation or the use of unspecified codes when more specific codes are available. Best practices include regular audits of coding accuracy, thorough documentation of patient encounters, and clear communication with payers regarding the patient's asthma management plan.

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 J45.90?

J45.90 covers unspecified asthma, which may include various asthma types not otherwise specified, such as allergic asthma, exercise-induced asthma, or occupational asthma when the specific type is not documented.

When should J45.90 be used instead of related codes?

J45.90 should be used when the specific type of asthma is not clearly documented in the patient's medical record. If the provider specifies the type of asthma, a more specific code should be selected.

What documentation supports J45.90?

Documentation should include a detailed patient history, symptom descriptions, triggers, treatment plans, and any diagnostic tests performed, such as spirometry results, to support the use of J45.90.