ED Coding and Reimbursement Alert

Question: A patient with a history of asthma who is now taking Albuterol reports to the ED with a barking cough. The physician performs a level-three evaluation and management service, notes a -croupy-sounding cough- and gives a final diagnosis of asthma. In this scenario, what ICD-9 code (or codes) should I report?

Michigan Subscriber

Answer: You should choose a diagnosis code that reflects the patient's asthma and the croupy sounds. ICD-9 does contain a diagnosis code that represents both.

On the claim:

- report 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem- focused history; an expanded problem-focused examination; and medical decision-making of moderate complexity) for the E/M

- link 493.90 (Asthma, unspecified) to 99283 to  represent the patient's asthma and croup. (Note: When you look up -Croup- in the ICD-9 index, it instructs you to use 493.9x  for asthmatic croup).