General Surgery Coding Alert

Question: When I use 491.9 to describe a patient's bronchitis, payers often deny the code and request additional information. How can I avoid this added step?

North Dakota Subscriber Answer: Choose a more accurate ICD-9 code instead of the unspecified chronic code that you-re using (491.9, Unspecified chronic bronchitis).
 
Here's how: When the physician indicates that a patient has -chronic bronchitis,- ICD-9 leads you to select 491.9. To maximize space, the selections provided on the encounter form might only offer the physician non-specific diagnoses. Your physician's documented asthma diagnosis may actually be more specific.
 
You should note that the physician may render treatment for -acute exacerbations- of chronic bronchitis. The term -acute- under 491.21 (Obstructive chronic bronchitis; with [acute] exacerbation) appears in the diagnosis definition. 
 
Therefore, if the physician sees a patient with an exacerbation of chronic bronchitis, you may report 491.21 because the ICD-9 convention for bracketed items means they are -nonessential modifiers.-
 
If you can't find the additional information necessary to choose a specific 491.xx code, you may have to educate your practice's physicians on the terms they need to use. Physicians may not realize the exact levels of specificity ICD-9 codes can achieve. 
 
If physicians are not giving you enough information to choose the right diagnosis, explain that their unspecified code selections may delay and/or reduce payment.