Primary Care Coding Alert

Focus on acute conditions and exacerbations to select the right code Your key to correctly reporting asthma, bronchitis and chronic obstructive pulmonary disease (COPD) lies in your physician's documentation and the patient's medical record. Making sure the documentation supports the physician's diagnosis and that you code for any associated acute conditions will ensure that you-re correctly reporting lung diagnoses. Look to Category 493 for Asthma With COPD One condition that can be associated with asthma is COPD. You can find all of the asthma codes in the 493 category of ICD-9 codes. When your physician diagnoses both COPD and asthma together, you-ll use the terms he documents in the medical record to finally settle on a code. The three asthma codes you-ll choose from are:

- 493.20 -- Chronic obstructive asthma; unspecified

- 493.21 -- Chronic obstructive asthma; with status asthmaticus

- 493.22 -- Chronic obstructive asthma; with (acute) exacerbation. Note: Most payers don't like nonspecific codes such as 493.20, so if possible check with your physician to see if the patient has status asthmaticus or an acute exacerbation so you can avoid using the unspecified code. If the patient doesn't have those conditions, your only option is to use 493.20.

If your physician documents status asthmaticus with any type of COPD, you should list that diagnosis first. You should only assign the fifth digit of 1 in this case (493.21, Obstructive chronic asthma; with status asthmaticus), not the fifth digit of 2 (493.22), says Cheryl Klarkowski, RHIT, coding specialist with Baycare Health Systems in Green Bay, Wis.

In black and white: -If status asthmaticus is documented by the provider with any type of COPD or with acute bronchitis, the status asthmaticus should be sequenced first,- according to chapter 8, section a.4. of the ICD-9-CM Guidelines, which you can find online at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide06.pdf. -It supersedes any type of COPD including that with acute exacerbation or acute bronchitis. It is inappropriate to assign an asthma code with fifth digit 2, with acute exacerbation, together with an asthma code with fifth digit 1, with status asthmaticus. Only the fifth digit 1 should be assigned.- For COPD and Bronchitis, Use 491.22 Another common condition that patients can have that is associated with COPD is bronchitis. When your physician documents both chronic obstructive bronchitis with an episode of acute bronchitis, you should report 491.22 (Obstructive chronic bronchitis; with acute bronchitis), Klarkowski says. You don't have to report 466.0 (Acute bronchitis) for the obstructive chronic bronchitis since the code descriptor for 491.22 specifies acute bronchitis.

Tip: If your physician documents that a patient has acute bronchitis with chronic obstructive bronchitis that  is causing an acute exacerbation, the bronchitis supersedes the exacerbation for your coding purposes, according to the ICD-9-CM Guidelines. Therefore, you [...]