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Thread: 491.21 vs 491.22

  1. #1

    Default 491.21 vs 491.22

    AAPC: Back to School
    If the physcian documents COPD/AECB, would the DX be 491.21?, as AECB stands for Acute Exacerbation Chronic Bronchitis. ( I do not see Acute Bronchitis in that abbreviation) I have read the guidelines in the ICD-9, chapter 8 part B, last sentence. So I am trying to understand how would this be coded as 491.22? A coding auditor coded this as 491.22.

    Please clarify. Thanks!

  2. #2
    Join Date
    Apr 2007


    I was looking at my 2009 Coders desk reference for diagnosis and it states

    If the physician documents acute bronchitis and excerbation of COPD, assign only the combination code of COPD with acute bronchitis (491.22)

    I hope this helps!

    This book really help with understanding the diagnosis codes a very wise investment!!

  3. #3
    Join Date
    Apr 2007


    I disagree on this one. I think it should be 491.21. Your provider is telling you this is an acute exacerbation, not acute bronchitis.

    The difference would be 491.22 is a new bronchitis in a patient with chronic obstructive bronchitis, 491.21 is an acute exacerbation of the existing chronic bronchitis.

    Question the auditor, find out why they assigned it. Could be human error or they could have a very good reason which I would love to see. This is one of my pet peeve code sets, so if I am using this one wrong I would appreciate knowing it. When I taught ICD-9 I harped on the COPD codes, I was so sick of seeing 496 on every patient. You would think after having COPD for 20 years they could figure out what was causing it.

    Laura, CPC
    Last edited by LLovett; 07-27-2009 at 10:24 AM.

  4. #4

    Default Reply to Katmryn78

    I agree with you. That is exactly what I was thinking!

  5. #5
    Join Date
    Apr 2007


    I would also have to go with the 491.21, as well.

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