Pulmonology Coding Alert

Pulmonologists diagnosing asthma will find 10 changes in the 2002 edition of the ICD-9 manual, including two new codes, one minor revision and two additions. Asthma by ICD-9 definition is the "transient narrowing of airway diameters in the bronchial tree, restricting airflow, and causing labored breathing and wheezing."
 
Although the changes are not radical, they are significant because they give physicians the option of labeling a patient's condition as "unspecified." This generalized condition is noted by the description for the "zero" in the fifth-digit subclassification of the asthma subcategory 493 that states "without mention of status asthmaticus or acute exacerbation or unspecified." In 2001, the "zero" in the fifth-digit subclassification included only the description of "without mention of status asthmaticus."
 
For example, when a patient presents with a condition that is diagnosed as extrinsic asthma, physicians can now use the diagnosis code 493.01 if the medical condition is status asthmaticus, 493.02 if it is acute exacerbation, and 493.00 for an unspecified condition.
Unspecified May Be Too Nebulous  
Although the "unspecified" option of labeling a patient's condition may give physicians more latitude in terms of a generalized diagnosis, some medical professionals fear it may compromise accuracy.
 
"We don't like to use unspecified codes," says Kristine Heth, CPC, University of South Carolina Medical School in Charleston, S.C.  "When the physician's diagnosis just says 'asthma,' you want to know why the patient has been coming to the doctor, and are they having problems. It is important to have an accurate code to put on our claim for reimbursement.  What we would like to see is a more specific diagnosis to determine the proper fifth digit or code. For example, is the patient being admitted to the hospital for acute exacerbation, status asthmaticus or uncontrolled asthma?"
 
Heth says coders need to know the severity of the condition or reason for the admission other than an unspecified diagnosis for asthma to ensure higher reimbursement and more exact records. The unspecified code should be used only as a last resort.

Other Code Changes and Modifications  
Physicians reporting a patient's diagnosis as extrinsic asthma or  "a transient stricture of airway diameters of bronchi due to environmental factors also called allergic (bronchial) asthma" can report 493.0x. Code 493.1x can be reported for intrinsic or late-onset asthma caused by pathophysiological disturbances, and 493.2x can be used for chronic obstructive asthma or asthma with chronic obstructive pulmonary disease (COPD). Code 493.9x can now be used for asthma unspecified, without mention of status asthmaticus or acute exacerbation or unspecified.
 
Chronic obstructive asthma with acute exacerbation is excluded from a patient who presents obstructive chronic bronchitis in 491.21. Code 466.0 for acute bronchitis has a subset that excludes acute bronchitis with bronchiectasis (494.1) and COPD (491.21)
 
Two new [...]