Primary Care Coding Alert

Question: When I use 491.9, payers often deny the code and request additional information. How can I avoid this added step?


Pennsylvania Subscriber


Answer: Your first step may be to choose a more specific ICD-9 code instead of the unspecified code that you-re now using (491.9, Unspecified chronic bronchitis). If the FP is circling 491.9 rather than a more specific diagnosis, look at his documentation for additional information.

Here's how: When the physician specifically identifies that a patient has -acute exacerbation,- you should assign 491.21 (Obstructive chronic bronchitis; with [acute] exacerbation). If you find the phrase -without exacerbation,- report 491.20 (... without exacerbation).

Both of these ICD-9 codes represent specific obstructive chronic bronchitis diagnoses.

If you can't find the additional information necessary to choose a specific 491.2x code, you may have to educate the physician on improving documentation and the need to be more specific when documenting diagnoses.

Explain that his lack of documentation is causing you to submit a nonspecific diagnosis code, and it is resulting in denials and delayed payment.