Internal Medicine Coding Alert

Question: When I use 491.9, payers often deny the code and request additional information. How can I avoid this added step?

Pennsylvania Subscriber
 
Answer: Choose a more specific ICD-9 code instead of the unspecified code (491.9, Unspecified chronic bronchitis) that you're now using. If the internist is circling 491.9 rather than a more specific diagnosis, look at his documentation for additional information.

Here's how: When the physician specifically identifies that a patient has "acute exacerbation," you should assign 491.21 (Obstructive chronic bronchitis; with [acute] exacerbation). If you find the phrase "without exacerbation," report 491.20 (... without exacerbation). Both of these ICD-9 codes represent specific obstructive chronic bronchitis diagnoses.

If you can't find the additional information necessary to choose a specific 491.2x code, you may have to educatethe physician on improving documentation and the need to be more specific in documenting diagnoses. Explain that his lack of documentation is causing you to submit a nonspecific diagnosis code and it is resulting in denials and delayed payment.