Learn about Cough Variant Asthma (CVA), also known as asthma with cough. This resource provides information on CVA diagnosis, clinical documentation tips for healthcare professionals, and relevant medical coding terms for accurate billing. Explore symptoms, treatment options, and differential diagnosis considerations for cough variant asthma. Improve your understanding of CVA management and ensure proper coding for this respiratory condition.
Also known as
Unspecified asthma, uncomplicated
Asthma without status asthmaticus or other complications.
Other specified asthma
Asthma not otherwise specified, including cough variant asthma.
Cough
Covers various types of cough, including those associated with asthma.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is cough the predominant symptom?
Yes
Evidence of airway hyperresponsiveness?
No
Do not code as Cough Variant Asthma. Consider other diagnoses.
When to use each related code
| Description |
|---|
| Asthma with cough as the main symptom. |
| Chronic cough lasting over 8 weeks without a clear cause. |
| Asthma with typical wheezing and shortness of breath. |
Coding CVA as unspecified asthma (J45.909) due to lack of supporting documentation for cough variant diagnosis.
Misdiagnosis due to overlapping symptoms with other respiratory conditions, leading to inaccurate coding (e.g., acute bronchitis).
Lack of clear documentation of objective findings supporting CVA diagnosis, impacting accurate code assignment and reimbursement.
Q: How to differentiate Cough Variant Asthma (CVA) from other chronic cough causes in adults?
A: Cough Variant Asthma (CVA), characterized by a chronic dry cough as the sole or predominant symptom, can be challenging to distinguish from other conditions like upper airway cough syndrome (UACS), gastroesophageal reflux disease (GERD), or non-asthmatic eosinophilic bronchitis (NAEB). Key differentiators for CVA include a positive response to bronchodilator challenge testing, demonstrating airway hyperresponsiveness, and the absence of symptoms like wheezing, shortness of breath, or chest tightness typically seen in classic asthma. Sputum eosinophilia may also be present. Consider implementing a stepwise diagnostic approach involving detailed patient history, physical exam, pulmonary function tests (PFTs) including spirometry and methacholine challenge, and exclusion of other cough etiologies. Explore how fractional exhaled nitric oxide (FeNO) can aid in identifying eosinophilic airway inflammation, a characteristic of CVA. If GERD or UACS are suspected, empiric treatment trials may be warranted to assess their contribution to the cough. Learn more about the differential diagnosis of chronic cough.
Q: What are the best evidence-based treatment strategies for managing Cough Variant Asthma (CVA or Asthma with Cough) in clinical practice?
A: The cornerstone of Cough Variant Asthma (CVA or Asthma with Cough) management is inhaled corticosteroids (ICS). Low-dose ICS therapy is often sufficient to control the chronic cough and address the underlying airway inflammation. For patients with more persistent or severe cough, a step-up approach may be necessary, including increasing the ICS dose or adding a long-acting beta-agonist (LABA). In some cases, leukotriene receptor antagonists (LTRAs) can be considered as add-on therapy. Clinicians should emphasize patient education on inhaler technique and adherence to prescribed therapy. Regular follow-up is essential to monitor treatment response and adjust medication as needed based on symptom control and lung function assessments. Consider implementing asthma action plans to empower patients in managing their condition and exacerbations. Explore how allergy testing and management can be beneficial in CVA patients with identified allergic triggers.
Patient presents with a chief complaint of chronic cough, consistent with a diagnosis of Cough Variant Asthma (CVA), also known as asthma with cough. The patient denies any significant wheezing, shortness of breath, or chest tightness. However, a detailed history reveals episodic cough, often nocturnal or triggered by exercise, cold air, or viral infections. Physical examination reveals clear lung sounds with no evidence of wheezing or rhonchi. Pulmonary function tests (PFTs), including spirometry, may demonstrate normal baseline values but reveal bronchial hyperresponsiveness with a positive methacholine challenge test. Differential diagnosis includes upper airway cough syndrome (UACS), gastroesophageal reflux disease (GERD), and non-asthmatic eosinophilic bronchitis. The diagnosis of CVA is supported by the patient's symptom presentation, absence of alternative explanations for the cough, and positive bronchial hyperresponsiveness. Treatment plan includes initiation of inhaled corticosteroids (ICS) as first-line therapy, with consideration for leukotriene modifiers or short-acting beta-agonists (SABA) as needed for cough control. Patient education regarding asthma triggers, medication adherence, and proper inhaler technique was provided. Follow-up scheduled to assess treatment response and adjust therapy as needed. ICD-10 code J45.909 (other specified asthma) and CPT codes for PFTs (94010, 94060), office visit (99213-99215), and medication management (99211) will be used for billing and coding purposes.