ED Coding and Reimbursement Alert

Question: A patient with extrinsic asthma reports to the ED in the throes of a severe asthma attack. While providing critical care services to the patient, the physician diagnoses the patient with status asthmaticus. Total critical care time is 37 minutes. On the claim, I reported 99291 with 493.00 as a diagnosis and received a denial. What did I do wrong?


Kentucky Subscriber
 

Answer: Your diagnosis coding was slightly off, which likely led to the denial. On your claim, you submitted 493.00 (Extrinsic asthma; unspecified) as the ICD-9 code, but you should have chosen 493.01 (- with status asthmaticus) instead.

Explanation: Patients sometimes require critical care services if they have asthma with status asthmaticus; reporting 493.01 as the diagnosis informs the payer of the patient's condition, while 493.00 does not specify the patient's status asthmaticus.

When you resubmit the claim, report the following:

- 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the critical care
- 493.01 linked to 99291 to represent the patient's asthma with status asthmaticus.

Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.