Posted on 20. Jul, 2009 by in Hot Coding Topics
Correctly reporting asthma, bronchitis, and chronic obstructive pulmonary disease (COPD) depends on the internist’s documentation and the patient’s medical record. Making sure the documentation supports the patient’s diagnosis and that you code for any associated acute conditions will ensure that you’re correctly reporting pulmonary diagnoses.
1. Look to 493 for Asthma With COPD
One condition that can be associated with asthma is COPD. You can find all of the asthma codes in the 493 category of the ICD-9 codes. When your physician diagnoses both COPD and asthma together, you’ll refer to his documentation in the medical record to settle on a code. The three asthma codes you’ll choose from are:
• 493.20 — Chronic obstructive asthma; unspecified
• 493.21 — … with status asthmaticus
• 493.22 — … with (acute) exacerbation.
Note: Most payers don’t like unspecified codes such as 493.20, so ask your physician whether the patient has status asthmaticus or an acute exacerbation so you can avoid using the unspecified code. If the patient doesn’t have either of those manifestations, your only option is to use 493.20.
In black and white: If your physician documents status asthmaticus with any type of COPD, you should report this diagnosis first. Assign the fifth digit of “1” in this case (493.21), not the fifth digit of “2” (493.22), says Cheryl Klarkowski, RHIT, coding specialist with Baycare Health Systems in Green Bay, Wis. Only the fifth digit “1” should be assigned. “Status asthmaticus” refers to a patient’s failure to respond to therapy administered during an asthmatic episode and is a life-threatening complication that requires emergency care. It supersedes any type of COPD, including that with acute exacerbation or acute bronchitis. It...
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