Reader Question: Exacerbated Asthma

Florida Subscriber

Answer: The 2001 ICD-9 manual introduced another fifth digit to the asthma codes to indicate exac-erbated asthma in four categories: extrinsic (493.0x), intrinsic (493.1x), chronic obstructive (493.2x) and not otherwise specified (493.9x). Only two fifth digits were available before 2001, which meant that the severity of the attack could not be indicated. If the condition did not reduce the degree or intensity of the symptoms, 493.x0 (asthma, without mention of status asthmaticus) was reported. If therapy did not reduce the degree or intensity of symptoms, 493.x1 (asthma, with status asthmaticus) was used.
 
A third option, which went into effect on Oct. 1, 2000, should be used as follows:
493.02 extrinsic asthma, with acute exacerbation
493.12 intrinsic asthma, with acute exacerbation
493.22 chronic obstructive asthma, with acute exacerbation
493.92 unspecified asthma, with acute exacerbation. 

The fifth digit, "2," lets the carrier know why all the work that was done was necessary. If "1" or "0" are used instead, the carrier may reduce payment for the service provided for reasons related to medical necessity.