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According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2026 Report, COPD is defined by post-bronchodilator spirometry showing a fixed ratio of FEV1/FVC 50 mmHg) Altered mental status (hypercarbia) Signs of Lower Respiratory Infection (J44.0 trigger) Fever, productive purulent cough, consolidation on CXR or CT chest Positive sputum culture, elevated WBC/CRP/procalcitonin Clinical diagnosis of pneumonia (J12J18) or acute bronchitis (J20.x) documented by provider Systemic / Advanced Disease Features Barrel chest (emphysema: hyperinflation, increased AP diameter) Prolonged expiratory phase, diminished breath sounds Clubbing (suggests comorbid bronchiectasis or malignancy not typical COPD alone) Peripheral edema, elevated JVP (cor pulmonale / right heart failure) Cachexia, weight loss (systemic inflammation) Cyanosis central (severe hypoxemia), peripheral Symptoms alone (dyspnea, wheezing, cough) should NOT be coded when COPD is established as the confirmed diagnosis