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 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 "chronic bronchitis," you should assign 491.0 (Simple chronic bronchitis). If you find the phrase "obstructive chronic bronchitis with acute bronchitis," report 491.22 (chronic bronchitis; with acute bronchitis). 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.xx code, you may have to educate your internist on the terms he needs to use. Explain that his unspecified code selection and/or lack of information is delaying payment.