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Pulmonology Coding Alert

Reader Questions:

Avoid Undefined Asthma and Assign the 5th Digit

Published on Thu Jul 07, 2005

Question: An elderly patient came to our practice with a history of asthma-induced bronchitis. Should I report an asthma code for the bronchitis?


Tennessee Subscriber


Answer: You should list 466.0 (Acute bronchitis) as the primary - and possibly only - diagnosis since this best represents the acute condition being treated. Remember to avoid using an unspecified asthma code (493.9x, 493.x0).
 
Be careful: Some insurers will deny unspecified asthma code 493.9x. Depending on the service you are reporting and whether the payer accepts the code, you may have to submit additional notes and ultimately have to select a specific code.

Better method: Before filing the claim, get the information you need to avoid using an unspecified code.

If you don't have access to the physician's notes, go back to the pulmonologist for more information, if the documentation supports assigning an asthma code at all.
If the pulmonologist simply mentions that the patient has a history of asthma, you may want to reconsider reporting 493.xx. Part of the decision depends on the place of service:
 

  • Inpatient: In this case, code the secondary diagnosis because you need as many comorbidity ICD-9 codes as possible to support the assigned E/M level in a facility setting.
     
  • Outpatient: Look at whether the visit addresses the asthma. If the patient's asthma is not causing any problems, the condition may not warrant using an ICD-9 code. But if the condition affects the plan of care - for instance, the patient's asthma medication impacts the bronchitis treatment - report the condition.

    You don't indicate that the patient's asthma is exacerbated (493.x2, ... with [acute] exacerbation) or that the condition requires treatment with a nebulizer, so the patient's asthma is probably stable. In this case, you would use a fifth-digit subclassification of 0.

    You can assign the appropriate specific asthma code with one more piece of information: the patient's asthma type. Use 493.00 for a stable extrinsic (typical) asthmatic and 493.10 for a stable intrinsic (less common) asthmatic.

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