ED Coding and Reimbursement Alert

Question: When I use 491.9 to describe a patient's bronchitis, payers often deny the code and request additional information, which means resubmitting the claim. How can I avoid this added step?

North Dakota Subscriber Answer: Choose a more accurate ICD-9 code instead of the unspecified chronic code that you-re using (491.9, Unspecified chronic bronchitis).
 
Here's how: When the physician indicates that a patient has -chronic bronchitis,- ICD-9 leads you to select 491.9. To maximize space, the selections provided on the encounter form might only offer the physician non-specific diagnoses.
 
Your physician's documented asthma diagnosis may actually be more specific.
 
It's important to note that in the ED, treatments are rendered for -acute exacerbations- of chronic bronchitis. The term -acute- under 491.21 (Obstructive chronic bronchitis; with [acute] exacerbation) appears in the diagnosis definition. 
 
So, if the patient is seen in the ED with an exacerbation of chronic bronchitis, you may report 491.21 because the ICD-9 convention for bracketed items means they have been determined to be -nonessential modifiers.-
 
If you can't find the additional information necessary to choose a specific 491.xx code, you may have to educate your facility's physicians on the terms they need to use.  Physicians may not realize the exact levels of specificity ICD-9 codes can achieve.
 
If physicians are not giving you enough info to choose the right diagnosis, explain that their unspecified code selection or lack of information may delay or reduce payment.