Otolaryngology Coding Alert

By following five tips to report the appropriate fourth- and fifth-digit asthma codes, you can ensure that your diagnosis coding meets your payers' medical-necessity requirements and avoid denials. 1. Identify the Asthma's Source With a Fourth Digit The fourth digit identifies what caused the patient's asthma. CPT contains four options for the fourth asthma digit: 493.0x Extrinsic asthma 493.1x Intrinsic asthma 493.2x Chronic obstructive asthma 493.9x Asthma, unspecified. Extrinsic means "coming from or originating from the outside," says Pamela Kulczar, CPC, CCP, medical office coordinator for the University of Texas Health Center at Tyler South Tyler Clinic in Tyler, Texas. In extrinsic asthma, an outside source, such as grass or pollen, causes the asthma. "Symptoms can include allergic rhinitis (477.x), atopic dermatitis (691.8), as well as asthma (493.xx)."

"Intrinsic asthma is situated entirely within or pertaining exclusively to a part," Kulczar says, citing Stedman's Medical Dictionary. "Something within the patient causes the asthma." The patient does not usually exhibit the same signs and symptoms of extrinsic asthma, such as rhinitis and dermatitis, but he may have similar asthma symptoms, she explains. Chronic obstructive asthma is for patients who have chronic obstructive pulmonary disease (COPD, 496). COPD is a general term for a temporary or permanent narrowing of the small bronchi. Pulmonologists, rather than otolaryngol-ogists, tend to treat COPD patients. Unspecified asthma describes the diagnosis when no further diagnosis is available. Whenever possible, you should avoid the generalized diagnosis for a more specific one, which will result in higher reimbursement and fewer denials. 2. Use a Fifth Digit to Describe the Asthma's Status To identify the asthma's current state during the patient's visit, assign the appropriate fifth-digit subclassification:

0 without mention of status asthmaticus or acute exacerbation or unspecified
1 with status asthmaticus
2 with acute exacerbation. For patients who do not have status asthmaticus or acute exacerbation, use the 0. Code 493.x0 is appropriate when the patient presents for a checkup and his or her asthma is controlled. The 1 indicates that the patient has status asthmaticus, which is a medical emergency and usually treated in the emergency department. Assign a 2 for patients who present with asthma that is currently exacerbated. This means something made the patient's asthma worse. 3. Paint an Accurate Picture With Both Digits ICD-9 instructs coders to "assign fifth-digit subclassification codes for those categories where they are available." "The fourth and fifth digits are important because they paint a more complete picture of the patient's condition at the time of the encounter," Kulczar says. Without a complete picture, the payer may deny the claim for lack of medical necessity. "Coders should be coding to the most specific code versus using the generic code," especially [...]