Decoding ICD-10-CM Code J40: Bronchitis, Not Specified as Acute or Chronic

The sound of a persistent, hacking cough is one of the most common refrains in clinics and emergency departments worldwide. It is the hallmark of bronchitis, an inflammation of the bronchial tubes that carry air to and from the lungs. For healthcare providers, diagnosing the root cause and nature of this cough is a fundamental task. For medical coders, translating that diagnosis into the precise alphanumeric language of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is an equally critical responsibility. Nestled within this complex coding system is ICD-10-CM Code J40: Bronchitis, not specified as acute or chronic—a code that represents a common yet potentially problematic area of clinical ambiguity. This code is not a diagnosis in itself but a placeholder, a reflection of the incomplete clinical picture at a specific point in time. Its misuse or overuse can lead to a cascade of issues, from inaccurate patient records and compromised care quality to denied claims and compliance headaches.

This comprehensive guide delves deep into the world of code J40, moving beyond a simple definition to explore its clinical significance, appropriate application, and the critical importance of precise documentation. We will dissect the anatomical and physiological underpinnings of bronchitis, draw clear lines between its acute and chronic forms, and provide real-world scenarios to illuminate when J40 is—and is not—the correct choice. Our goal is to equip clinicians, coders, students, and healthcare administrators with the knowledge to navigate this diagnostic gray area with confidence, ensuring that every use of code J40 is justified, defensible, and, most importantly, in the best interest of the patient.

Understanding the ICD-10-CM System: A Brief Primer {#icd10-primer}

Before focusing on J40, it is essential to understand the system it belongs to. The ICD-10-CM is the United States’ clinical modification of the World Health Organization’s ICD-10, used to classify and code all diagnoses, symptoms, and procedures recorded in conjunction with hospital care. Its primary purposes are:

• Standardization: It provides a universal language for describing health conditions, enabling clear communication among healthcare providers, researchers, and public health officials across the globe.

• Epidemiology and Public Health: By tracking the incidence and prevalence of diseases, it helps identify outbreaks, allocate resources, and shape public health policy.

• Billing and Reimbursement: It is the foundation of the medical billing process. Accurate ICD-10-CM codes are required by insurers, including Medicare and Medicaid, to justify payment for services rendered.

• Quality Measurement: Codes are used to track patient outcomes, hospital readmission rates, and the quality of care provided.

The structure of an ICD-10-CM code is hierarchical. The first character is always alphabetic. The second and third characters are numeric, representing the general category of the disease. Characters four through seven provide increasing specificity regarding etiology, anatomical site, severity, and other clinical details. Code J40 falls under Chapter X: Diseases of the Respiratory System (J00-J99), specifically within the block “Other diseases of upper respiratory tract (J30-J39)” and, more precisely, serves as a bridge to the codes for lower respiratory diseases like acute and chronic bronchitis.

ICD-10-CM Code J40: A Deep Dive {#j40-deep-dive}

Code Definition and Official Description {#code-definition}

ICD-10-CM Code J40 is officially described as: “Bronchitis, not specified as acute or chronic.”

This description is intentionally vague. It is a “catch-all” code for a diagnosed bronchitis where the medical documentation does not allow the coder to definitively classify it as either acute (a short-term, often viral illness) or chronic (a long-term, persistent condition, often linked to smoking or environmental exposures).

It is crucial to note what J40 includes and excludes:

• Includes: The ICD-10-CM manual indicates that J40 includes conditions described as:

  • Bronchitis NOS (Not Otherwise Specified)

  • Tracheobronchitis NOS

• Excludes1: Bronchitis with tracheitis NOS (J20.-). This is a critical distinction. If the documentation specifies both bronchitis and tracheitis without clarifying the duration, it defaults to the acute bronchitis code range (J20.-), not J40.

• Parent Code Notes: J40 is a subcategory of codes J40-J43, which are “Bronchitis, chronic and unspecified.” This grouping highlights its role as an “unspecified” code within the broader chronic bronchitis family, but it is not itself a chronic code.

The Clinical Picture of “Unspecified” Bronchitis {#clinical-picture}

A patient presenting with symptoms that lead to a diagnosis coded as J40 typically exhibits a classic set of respiratory complaints, but their history or the clinician’s note lacks the detail needed for a more specific classification. The clinical presentation often includes:

• Cough: The cardinal symptom. It may be productive (producing sputum) or dry and hacking. The color of the sputum (clear, white, yellow, green) is noted but is not a reliable differentiator between viral and bacterial causes.

• Sputum Production: Ranging from minimal to copious amounts.

• Chest Discomfort: Often described as a soreness or rawness beneath the breastbone, worsened by coughing.

• Wheezing or Shortness of Breath: Due to inflammation and narrowing of the airways.

• Low-Grade Fever and Fatigue: Common, especially if the cause is infectious.

• Rhinorrhea (runny nose) and Sore Throat: Frequently accompany bronchitis that follows an upper respiratory infection.

On physical examination, the clinician may find:

• Auscultatory Findings: Rhonchi (low-pitched, rattling sounds) or wheezes (high-pitched, musical sounds) heard over the lung fields. These sounds are caused by air moving through narrowed airways filled with secretions.

• Absence of Focal Signs: A key differentiator from pneumonia is the lack of signs like egophony (a change in the sound of “E” to “A” heard through a stethoscope) or dullness to percussion, which would suggest lung consolidation.

Anatomy and Pathophysiology of Bronchitis {#anatomy-pathophysiology}

To understand bronchitis, one must first understand the anatomy of the bronchial tree. When we inhale, air passes through the trachea (windpipe), which then divides into the right and left main bronchi. These bronchi continue to branch into smaller and smaller bronchi and finally into the bronchioles, which end in the alveoli—the tiny air sacs where gas exchange occurs.

The inner lining of the bronchi is the mucosa, which contains goblet cells that produce mucus and ciliated cells that move the mucus, along with trapped particles and pathogens, upward and out of the lungs.

Bronchitis is an inflammation of this bronchial mucosa. The pathophysiological process unfolds as follows:

1. Insult: An irritant (e.g., virus, bacteria, smoke, chemical) damages the mucosal cells.

2. Inflammatory Response: The body’s immune system responds by sending inflammatory cells (like neutrophils and lymphocytes) to the site. Blood vessels dilate and become more permeable, leading to swelling (edema) of the bronchial walls.

3. Hypersecretion: The goblet cells increase mucus production, and the damaged cilia are less effective at clearing it.

4. Airway Obstruction and Hyperreactivity: The combination of mucosal edema and excess, thick mucus narrows the airways. This obstruction and the inflammatory mediators themselves can cause the smooth muscles in the bronchial walls to spasm (bronchospasm), further narrowing the airways. This leads to the classic symptoms of cough, wheezing, and shortness of breath.

The Critical Distinction: Acute vs. Chronic Bronchitis {#critical-distinction}

The single most important factor in moving away from code J40 is determining whether the bronchitis is acute or chronic. This distinction is based on duration, etiology, and clinical impact.

Acute Bronchitis (J20.-) {#acute-bronchitis}

Acute bronchitis is a self-limiting inflammation of the large airways, most commonly caused by a viral infection (e.g., rhinovirus, influenza, RSV). It is one of the most frequent conditions for which patients seek medical care.

• Duration: The cough typically lasts up to 3 weeks, though it can persist for longer (post-viral cough).

• Etiology: >90% of cases are viral. Bacterial causes are rare but can include Bordetella pertussis (whooping cough), Mycoplasma pneumoniae, and Chlamydia pneumoniae.

• ICD-10-CM Coding: The codes for acute bronchitis (J20.-) are highly specific and require a fifth or sixth character to identify the causative organism.

  • J20.0 – Acute bronchitis due to Mycoplasma pneumoniae

  • J20.5 – Acute bronchitis due to respiratory syncytial virus (RSV)

  • J20.6 – Acute bronchitis due to rhinovirus

  • J20.9 – Acute bronchitis, unspecified (used when the cause is not identified, but the acute nature is clear from documentation)

Chronic Bronchitis (J41.-, J42, J44.-) {#chronic-bronchitis}

Chronic bronchitis is a more serious, progressive condition. It is clinically defined as a productive cough that persists for at least three months in two consecutive years, in the absence of any other underlying cause.

• Duration: Long-standing and persistent.

• Etiology: Primarily caused by long-term exposure to airway irritants, with cigarette smoking being the most significant risk factor. Other irritants include air pollution, dust, and chemical fumes.

• Pathophysiology: It is a type of Chronic Obstructive Pulmonary Disease (COPD) and is characterized by hyperplasia (overgrowth) of mucus-secreting glands in the bronchi, leading to chronic, excessive mucus production. This is known as “small airways disease” and “chronic bronchial hypersecretion.”

• ICD-10-CM Coding:

  • J41.0 – Simple chronic bronchitis: Characterized by mucoid sputum without obstruction.

  • J41.1 – Mucopurulent chronic bronchitis: Characterized by persistently mucopurulent (pus-containing) sputum.

  • J41.8 – Mixed simple and mucopurulent chronic bronchitis.

  • J42 – Unspecified chronic bronchitis: Used when the documentation states “chronic bronchitis” but does not specify the type (simple or mucopurulent).

  • J44.- – Other chronic obstructive pulmonary disease: This code is used when chronic bronchitis is associated with emphysema or when it causes airflow obstruction. J44.9 is a very common code for COPD, unspecified.

Comparative Table: Acute vs. Chronic vs. Unspecified Bronchitis {#comparative-table}

The following table provides a clear, side-by-side comparison of the key features of acute, chronic, and unspecified bronchitis to aid in differentiation.

When is it Appropriate to Use Code J40? Clinical Scenarios and Documentation Requirements {#appropriate-use}

Code J40 should be used sparingly and only when the medical documentation provides no clues to determine if the condition is acute or chronic. Its use is a signal that the clinical picture is incomplete. Here are some realistic scenarios where J40 might be the correct, albeit temporary, code.

Scenario 1: The Initial, Undifferentiated Presentation {#scenario-1}

A 45-year-old patient presents to a busy urgent care center with a 5-day history of cough and yellow sputum. They have no significant past medical history documented in this new patient encounter. The clinician performs a rapid exam, rules out pneumonia, and diagnoses “bronchitis.” They prescribe symptomatic care and advise the patient to follow up if symptoms worsen or do not resolve in a week. The note does not use the words “acute” or “chronic.”

• Coding Rationale: In this context, the coder has no basis to assign an acute (J20.9) or chronic (J42) code. The documentation only supports “bronchitis.” Therefore, J40 is the correct code. The short duration might suggest acute, but the coder cannot make assumptions; they must code based on the documentation provided.

Scenario 2: Insufficient Documentation from Referral Sources {#scenario-2}

A patient is admitted to the hospital for an elective surgery (e.g., knee replacement). Their past medical history, as listed on the admission form by the consulting internist, includes “bronchitis.” There is no additional information in the chart specifying whether this is a past episode of acute bronchitis or an ongoing diagnosis of chronic bronchitis.

• Coding Rationale: The coder reviewing the chart for comorbidities cannot query the provider retrospectively for an elective admission. Without specification, the only code that accurately reflects the documentation is J40.

Scenario 3: Resolving Bronchitis of Unknown Origin {#scenario-3}

A patient follows up with their primary care physician 4 weeks after an initial illness. The patient states their cough is “almost gone” but still present. The physician’s note reads: “Patient with resolving bronchitis. Doing well.” The original encounter note is not available, and the current note does not reference the initial onset or total duration.

• Coding Rationale: A 4-week cough could be the tail end of an acute process or a flare of an undiagnosed chronic condition. The documentation “resolving bronchitis” is not specific. Assigning J40 is the most accurate choice based on the information at hand.

Coding Guidelines, Conventions, and Pitfalls to Avoid {#coding-guidelines}

The “Unspecified” Code Designation {#unspecified-designation}

The ICD-10-CM system contains many “unspecified” codes. They are necessary and legitimate tools for coding when specific clinical detail is unavailable. However, they are often flagged by payers and auditors because they can indicate poor documentation or a lack of diagnostic workup. The consistent use of unspecified codes for a provider or facility can lead to:

• Increased Scrutiny: Claims may be denied or subjected to pre-payment review.

• Downcoding: A payer may reassign a code to a less specific one (though J40 is already unspecified), reducing reimbursement.

• Quality Metric Penalties: In value-based care models, unspecified codes can negatively impact performance scores related to disease management.

Documentation is King: Queries and Clarifications {#documentation-king}

The single most powerful tool to avoid J40 is robust clinical documentation. Coders are trained to “code what they see.” If the documentation is vague, the code will be vague. Clinicians can ensure precision by:

• Using Specific Terminology: Always use “acute bronchitis” or “chronic bronchitis” in the assessment/diagnosis.

• Including Duration: State the onset and duration of the current episode (e.g., “cough for 10 days”).

• Noting Pertinent History: For patients with a known history of COPD or chronic bronchitis, explicitly state it (e.g., “acute exacerbation of chronic bronchitis”).

• Being Responsive to Queries: If a coder or clinical documentation integrity (CDI) specialist sends a query asking for clarification (e.g., “Is the bronchitis acute or chronic?”), providing a prompt and clear answer is crucial for accurate coding.

Common Coding Errors and How to Prevent Them {#coding-errors}

1. Defaulting to J40 for Every Cough: This is a major error. If the documentation says “acute bronchitis,” J20.9 must be used, not J40.

2. Confusing J40 with J20.9: J20.9 is for Acute bronchitis, unspecified. J40 is for bronchitis with no specification of acute or chronic. They are not interchangeable.

3. Ignoring Excludes1 Notes: As mentioned, if the diagnosis is “bronchitis and tracheitis,” the correct code is from the J20.- series, not J40. Failing to follow Excludes1 notes is a direct coding violation.

4. Coding Suspected Conditions: A coder can only code confirmed diagnoses. If the clinician writes “rule out bronchitis,” it cannot be coded. The coder must wait for a definitive diagnosis.

Differential Diagnoses: Ruling Out Other Conditions {#differential-diagnoses}

A diagnosis of “bronchitis” is often one of exclusion. Many conditions can mimic its symptoms, and a key part of the clinical process is ruling out these more serious or different entities.

Upper Respiratory Infections (J00-J06) {#upper-respiratory}

The common cold (J00) or pharyngitis (J02.9) can present with a cough. However, the primary symptoms are usually rhinorrhea, nasal congestion, and sore throat, with the cough being a secondary, less prominent feature.

Pneumonia (J12-J18) {#pneumonia}

This is the most critical condition to rule out. Pneumonia involves infection and inflammation of the lung alveoli themselves, not just the bronchi. Key differentiators include:

• Systemic Illness: Higher fever, chills, and significant malaise.

• Focal Lung Findings: Crackles (rales), egophony, or dullness to percussion on exam.

• Chest X-ray: The definitive test, showing an opacity or infiltrate.

Asthma (J45.-) {#asthma}

Asthma is characterized by reversible airway obstruction and hyperresponsiveness. While cough-variant asthma exists, asthma typically presents with episodic wheezing, chest tightness, and shortness of breath, often triggered by allergens, exercise, or cold air. Spirometry showing reversibility with a bronchodilator is diagnostic.

Bronchiectasis (J47) {#bronchiectasis}

A chronic condition involving permanent, abnormal widening of the bronchi, leading to a chronic, productive cough with large volumes of purulent sputum. It is often diagnosed with a high-resolution CT scan of the chest.

Postnasal Drip and Gastroesophageal Reflux Disease (GERD) {#gerd}

These are common causes of chronic cough. Postnasal drip from rhinitis or sinusitis can cause throat clearing and a cough that is often worse at night. GERD can cause a cough due to irritation of the esophagus and larynx by stomach acid, frequently occurring after meals or when lying down.

Diagnostic Approach and Patient Workup {#diagnostic-approach}

The diagnostic workup for bronchitis is primarily clinical, with testing reserved for cases where the diagnosis is uncertain or a more serious condition is suspected.

History and Physical Examination {#history-physical}

This is the cornerstone of diagnosis. The clinician will focus on:

• History of Present Illness: Onset, duration, and character of cough and sputum; presence of fever, wheezing, or dyspnea.

• Past Medical History: History of asthma, COPD, GERD, or allergies.

• Social History: Smoking status is paramount. Occupational exposures (dust, chemicals).

• Physical Exam: Vital signs (especially temperature and oxygen saturation), thorough lung auscultation, and examination of the upper airway and sinuses.

Diagnostic Testing: From Routine to Advanced {#diagnostic-testing}

• Pulse Oximetry: A non-invasive test to measure blood oxygen saturation. Helps assess the severity of respiratory involvement.

• Chest X-Ray (Radiography): Not routinely indicated for simple acute bronchitis but is essential if pneumonia is suspected (e.g., fever >100.4°F, tachycardia, tachypnea, focal lung findings).

• Sputum Culture: Generally not recommended for routine cases. May be considered if the patient is immunocompromised, has a suspected bacterial infection not responding to initial care, or if pertussis is suspected.

• Pulmonary Function Testing (Spirometry): Crucial for evaluating suspected chronic bronchitis or COPD. It measures the volume and flow of air during forced breath maneuvers, identifying the presence and severity of airflow obstruction.

• Blood Tests: A complete blood count (CBC) may show an elevated white blood cell count in bacterial infections, but this is non-specific. Arterial blood gas (ABG) is reserved for patients with severe respiratory distress.

Treatment and Management Strategies for Bronchitis Symptoms {#treatment-management}

Treatment depends entirely on whether the condition is acute or chronic. Since J40 represents an unspecified state, management is initially supportive and aimed at symptom relief while the clinical picture clarifies.

Symptomatic Management and Supportive Care {#symptomatic-management}

This is the mainstay of treatment for acute and unspecified bronchitis.

• Hydration: Drinking plenty of fluids helps to thin mucus, making it easier to expectorate.

• Humidification: Using a cool-mist humidifier or taking steamy showers can soothe irritated airways and loosen secretions.

• Rest: Allowing the body to recover from the inflammatory process.

• Honey: For adults and children over one year old, honey in warm water or tea has been shown to be effective at reducing cough frequency and severity.

• Avoiding Irritants: Especially tobacco smoke.

Pharmacological Interventions {#pharmacological-interventions}

• Antitussives: Cough suppressants like dextromethorphan can be useful for dry, hacking coughs that interfere with sleep. They should be used cautiously with productive coughs.

• Expectorants: Guaifenesin is thought to thin mucus, making it easier to cough up. Evidence for its efficacy is mixed.

• Bronchodilators: Inhaled beta-agonists like albuterol can be helpful if significant wheezing or bronchospasm is present. They are not recommended for routine use in non-wheezing patients.

• Analgesics/Antipyretics: Acetaminophen or ibuprofen for fever and malaise.

The Role of Antibiotics: Why They Are Usually Not Indicated {#antibiotics-role}

The vast majority of acute bronchitis cases are viral, and antibiotics are not effective against viruses. Inappropriate antibiotic use contributes to the global crisis of antimicrobial resistance, exposes patients to potential side effects unnecessarily, and increases healthcare costs. Guidelines from the American College of Chest Physicians and the CDC strongly recommend against the routine use of antibiotics for uncomplicated acute bronchitis.

Antibiotics may be considered only in very specific scenarios, such as a confirmed or highly suspected bacterial cause (e.g., pertussis) or in a patient with known COPD experiencing an acute exacerbation where bacterial infection is suspected.

Lifestyle Modifications and Patient Education {#lifestyle-modifications}

For patients where chronic bronchitis is a possibility or confirmed, long-term management is vital.

• Smoking Cessation: This is the single most important intervention. It is the only measure proven to slow the progression of COPD and chronic bronchitis.

• Pulmonary Rehabilitation: A program of exercise, education, and support for patients with chronic respiratory disease.

• Vaccinations: Annual influenza vaccine and pneumococcal vaccines (PCV15/PCV20 and PPSV23) are crucial to prevent respiratory infections that can cause severe exacerbations.

The Impact of Precise Coding: Clinical, Administrative, and Financial Implications {#impact-coding}

Accurate coding, and by extension, precise documentation that avoids unnecessary J40 codes, has far-reaching consequences beyond mere billing.

Quality of Patient Care and Population Health Management {#quality-care}

• Accurate Patient Records: A patient’s electronic health record (EHR) is a lifelong story. A code of J40 offers little insight. A code of J42 (chronic bronchitis) or J44.9 (COPD) triggers important clinical decision support, such as prompts for smoking cessation counseling, spirometry, and vaccinations.

• Care Coordination: When a patient sees a specialist, accurate problem lists derived from specific codes allow for better-informed care.

• Research and Epidemiology: Public health officials rely on coded data to track disease trends. Widespread use of unspecified codes like J40 obscures the true burden of acute versus chronic respiratory diseases, hampering effective public health planning and resource allocation.

Reimbursement, Audits, and Compliance Risks {#reimbursement-audits}

• DRG Assignment: In the inpatient setting, diagnoses are grouped into Diagnosis-Related Groups (DRGs) that determine a fixed payment. A code of J40 may not impact the DRG, but a more specific code like J44.9 (COPD) for a patient with respiratory failure could place the case in a higher-paying DRG, appropriately reflecting the resources used.

• Risk Adjustment: In Medicare Advantage and other risk-based payment models, patients are assigned a risk score based on their diagnoses. Chronic conditions like COPD (J44.9) carry a higher risk score and thus higher reimbursement than an unspecified code like J40, which is often ignored in risk models. Undercoding chronic conditions can significantly underfund a healthcare organization.

• Audit Defense: In the event of an audit by a Recovery Audit Contractor (RAC) or other payer, having specific documentation that supports a specific code is the best defense against recoupment. A chart with a diagnosis of “bronchitis” and a coded J40 is vulnerable, as the auditor may argue it was, in fact, a simple upper respiratory infection that should not have been billed at a higher level.

Conclusion: Summarizing the Content of the Article in Three Lines {#conclusion}

Code J40 serves as a necessary placeholder for bronchitis when clinical documentation lacks the specificity to determine its acute or chronic nature. Its appropriate use hinges on ambiguous provider notes, but its overuse signals a failure in the clinical documentation process that can compromise patient care, data integrity, and accurate reimbursement. Ultimately, moving from the ambiguity of J40 to precise codes for acute or chronic bronchitis requires a collaborative commitment to detailed documentation from clinicians and diligent querying from coders.

Frequently Asked Questions (FAQs) {#faqs}

1. Can I use code J40 for a patient I know is a smoker with a long-standing cough, even if the doctor didn’t write “chronic”?
No. As a coder, you must code strictly based on the physician’s documentation. You cannot infer a diagnosis or its chronicity based on patient history alone. If the documentation only says “bronchitis,” you must code J40. The correct action is to query the provider for clarification.

2. What is the difference between J40 and J20.9?
J20.9 is “Acute bronchitis, unspecified.” It is used when the documentation explicitly states the bronchitis is “acute,” even if the cause is unknown. J40 is used when the documentation simply says “bronchitis” with no mention of “acute” or “chronic.”

3. A patient has “bronchitis and tracheitis.” Why can’t I use J40?
Per the ICD-10-CM Official Guidelines, an “Excludes1” note for J40 indicates that bronchitis with tracheitis NOS (not otherwise specified) should be coded to J20.- (acute bronchitis). These notes mean the two conditions should not be coded together; the condition described in the Excludes1 note is not included here.

4. How can clinicians easily improve documentation to avoid J40?
The simplest and most effective habit is to always include the descriptor “acute” or “chronic” in the assessment and plan when diagnosing bronchitis. For example, instead of “Assessment: Bronchitis,” write “Assessment: Acute bronchitis” or “Assessment: Chronic bronchitis.”

5. Is J40 a billable code?
Yes, ICD-10-CM code J40 is a billable code and can be used for reimbursement purposes. However, as discussed, its use may trigger reviews and does not accurately reflect the complexity or chronicity of a patient’s condition, which can impact risk-adjusted payments.

Additional Resources {#additional-resources}

• CDC – ICD-10-CM Official Guidelines for Coding and Reporting: The definitive source for coding rules and conventions.
  https://www.cdc.gov/nchs/icd/icd-10-cm.htm

• American Health Information Management Association (AHIMA): A premier association for health information management professionals, offering resources on clinical documentation improvement (CDI).
  https://www.ahima.org/

• American Academy of Professional Coders (AAPC): A leading organization for medical coders, providing certification, training, and updates on coding practices.
  https://www.aapc.com/

• Global Initiative for Chronic Obstructive Lung Disease (GOLD): Provides evidence-based strategy documents for the diagnosis, management, and prevention of COPD/Chronic Bronchitis.
  https://goldcopd.org/

• American College of Chest Physicians (CHEST): Clinical practice guidelines for the diagnosis and management of cough and bronchitis.
  https://www.chestnet.org/

Date: October 8, 2025
Author: The  Medical Content Team
Disclaimer: The information contained in this article is intended for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or code assignment. The author and publisher are not responsible for any errors or omissions or for any consequences from the application of the information presented.