ED Coding and Reimbursement Alert

Question: Should I code documentation that states -acute status asthmaticus- as status asthmaticus or with (acute) exacerbation?


New York Subscriber

Answer: The physician probably meant -status asthmaticus,- but you should double-check the doctor's intention, because -acute- and -status- describe different conditions. The rest of the notes and the evaluation and management code can also point you to the correct fifth-digit subclassification to use with 493.xx (Asthma).

You should use a fifth digit of -1- for asthma with status asthmaticus, such as 493.01 (Extrinsic asthma with status asthmaticus). Status asthmaticus defines a severe and prolonged asthma attack--the term implies a severity rating and a duration definition.

Status asthmaticus is life-threatening and frequently implies inpatient intensive care for treatment. Therefore, you will usually use 493.x1 with a high-level ED code, such as 99284 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a detailed history, a detailed examination, and medical decision-making of moderate complexity) or 99285 (-within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history, a comprehensive examination, and medical decision-making of high complexity).

Additionally, you may need to report critical care services with 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and (if appropriate) +99292 (-each additional 30 minutes).
 
Fallback position: If your physician really meant that it was just an acute exacerbation, then you should instead assign a fifth digit of -2- (493.x2) to indicate asthma with (acute) exacerbation.

Acute exacerbation means a patient has developed worsening symptoms that have just happened. The term does not provide much severity information. A patient could go from no symptoms to just a little cough, yet the physician could still define the condition as acute exacerbation.