Internal Medicine Coding Alert

You can finally code for animal hair, dander

If you want to avoid denials this fall when your internist treats allergy or bronchitis patients, you should know how to use new ICD-9 codes 477.2 and 491.22.

And you have little time to spare. On Sept. 30, you should add 477.2 (Allergic rhinitis, due to animal [cat] [dog] hair and dander) and 491.22 (Obstructive chronic bronchitis with acute bronchitis) to your respiratory ICD-codes, because CMS ended the coding grace period earlier this year.

When animal (cat, dog, etc.) hair and dander cause allergic rhinitis, coders and physicians should now report 477.2. The addition of 477.2 to ICD-9 allows for more specificity as to the cause of the allergic rhinitis cases you report, says Roger Hettinger, CPC, CMC, CCS-P, coding specialist at Sioux Valley Clinic in Sioux Falls, S.D.

Old way: Before CMS introduced 477.2, no code existed specifically for allergic rhinitis due to animal hair and dander. That means you now report 477.8 (Allergic rhinitis; due to other allergen) if the patient appeared with allergic symptoms for animals, Hettinger says.

Extra: On Oct. 1, you should add 477.2 to other rhinitis-related ICD-9 codes, such as 477.0 (Allergic rhinitis; due to pollen), 477.1 (... due to food), 477.8 (... due to other allergen), and 477.9 (... cause unspecified).

If your internist's bronchitis patient develops yellow mucous, which appears to be due to an infection, you should use the new ICD-9 code 491.22 to report obstructive bronchitis with acute bronchitis, says Alan L. Plummer, MD, professor of medicine in the division of pulmonary, allergy and critical care at the Emory University School of Medicine in Atlanta.

"It may be difficult to differentiate between an acute decompensation due to infection and another cause (such as air pollution) in a patient with chronic obstructive bronchitis, but the new code 491.22 allows you to make that distinction," Plummer adds.

Old way: Prior to the new code, you would report 491.21 for a patient with chronic obstructive bronchitis who developed acute bronchitis. Previously, you could not use 491.21 as a specific indication of chronic bronchitis. The ICD-9 manual grouped that condition with acute bronchitis with chronic obstructive pulmonary disease, acute exacerbation of chronic obstructive pulmonary disease, and emphysema with both acute and chronic bronchitis, Plummer says.

Now, with the addition of 491.22, your practice can take advantage of the new level of specificity and collect full pay for appropriate billing. To review a full listing of the new ICD-9 codes, visit the CMS Web site http://www.cms.hhs.gov/medlearn/icd9code.asp#coding.