Pulmonology Coding Alert

Question: The pulmonologist treats a new patient with a chronic cough and abnormal sputum. During an E/M encounter, the physician makes a diagnosis of obstructive chronic bronchitis without acute exacerbation. How many diagnosis codes should I include on the claim? Idaho Subscriber Answer: Though the patient had specific symptoms, the pulmonologist reached a diagnosis, meaning that the primary diagnosis coding should reflect the condition, reporting the symptoms as secondary to demonstrate the acuity prompting the visit. On your claim, report 491.20 (Obstructive chronic bronchitis; without exacerbation) to represent the patient's bronchitis. However, if the encounter documentation specifies acute exacerbation, report 491.21 (... with [acute] exacerbation) instead of 491.20. -- Answers to You Be the Coder and Reader Questions were answered/reviewed by Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta; and Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.