I think it depends on your company’s internal rules, if they cover it. Where I work, we would pick that up. COPD is a chronic condition that, once the patient has it, never truly resolves and is always relevant to the patient’s medical care. CMS and coding guidelines allow for such conditions to be coded, even from patient history, when there’s nothing documented to contradict it (like, say, a history of lung transplant).

In addition, the med list can always be considered an indication of active care as the provider (presumably) reviews and validates each medication at each encounter where it is included in the documentation. When a provider prescribes or validates a medication that is commonly used as a treatment for a chronic condition such as COPD, and the condition has been documented on the note, the provider (again presumably) is at least considering how that condition is affected by the medication, even if that’s not the main reason it was prescribed.

Remember, the ICD guideline for outpatients encounters is “Code all documented conditions that coexist at the time of the encounter/visit, and require or affect patient care, treatment or management.” With a condition like COPD, it affects MDM for anything the provider does related to breathing.

Of course, some coders and companies are much more conservative about their interpretation and documentation requirements.