ED Coding and Reimbursement Alert

Question: A patient who says they have a long history of mild persistent asthma presents to your emergency department with coughing, wheezing, chest tightness, and shortness of breath. The patient also complains they’re experiencing symptoms associated with their hay fever allergy. After a physical examination, the ED physician diagnoses the patient with an acute exacerbation of their mild persistent asthma due to hay fever. Which code or codes should we report for this visit?

Arizona Subscriber

Answer: For this scenario, you’ll assign J45.31 (Mild persistent asthma with (acute) exacerbation) and J30.1 (Allergic rhinitis due to pollen) to report the patient’s acute exacerbation of asthma due to hay fever. ICD-10-CM code J30.1 features an additional synonym of “hay fever,” so you can assign this code the specify the cause of the patient’s exacerbated asthma.

The J45.- (Asthma) parent code features an Includes note that contains “hay fever with asthma,” but the descriptor for J45.901 (Unspecified asthma with (acute) exacerbation) doesn’t paint the full picture of the patient’s condition. The exacerbation must be described and linked to the hay fever, and a separate code for the hay fever should be reported. Providers should always document cause-and-effect, and be as specific as possible.

At the same time, the codes in the J45.- category require 4th and 5th characters to complete each code. The additional characters allow you to specify a variety of other factors related to the patient’s condition. Providers should document asthma by its severity, chronicity, and presence of exacerbation or status asthmaticus (asthma that isn’t resolved with medications).

In addition, you’ll report the appropriate evaluation and management (E/M) code from the 99281-99285 range to reflect the provider’s work evaluating the patient and making the diagnosis.