Medicare Compliance & Reimbursement

Remember to report the cause of asthma exacerbation.

With allergy season in full swing, you’ll need to be ready to correctly report asthma exacerbation encounters. But it’s not as easy as you think and coders may need to sift through notes in the medical record to find the right code.

Dive in to quash the following asthma and allergy coding myths.

Myth 1: You don’t need cause-and-effect coding for asthma exacerbation.

You will always code the cause of a condition if the provider documents it in the medical record.

“The cause and effect of asthma must be documented and coded. Providers should document the asthma by its severity and chronicity, and the presence of the exacerbation or if the condition is status asthmaticus,” says Sheri Poe Bernard, CPC, CRC, CDEO, CCS-P, CPC-I, managing consultant at Granite GRC Consulting in Salt Lake City, Utah.

Scenario: An established patient presents to the practice with an exacerbation of their moderate persistent asthma. The patient’s neighbor had been mowing their lawn, and the patient’s asthma flared up. The provider diagnoses the patient with an acute exacerbation of moderate persistent asthma due to hay fever.

This is a situation where you’ll use two ICD-10-CM codes to report the provider’s diagnosis. “The exacerbation must be described and linked to the hay fever, and a separate code for the hay fever should be reported,” Bernard says.

Assign J45.41 (Moderate persistent asthma with (acute) exacerbation) to report the patient’s asthma exacerbation. Next, you’ll report the cause of the asthma attack with J30.1 (Allergic rhinitis due to pollen). Among J30.1’s additional synonyms you’ll find hay fever, which is the provider’s documented diagnosis.

Critical: Though the scenario focuses on “moderate persistent asthma,” a patient may present with more severe symptoms that may fall under the helm of “status asthmaticus.”

Status asthmaticus is best defined as an acute flare-up of the patient’s asthma that doesn’t respond to bronchodilators initially — and the ICD-10-CM code associated with the condition is J45.52 (Severe persistent asthma with status asthmaticus).

The condition is very dangerous and requires urgent medical attention. A patient experiencing status asthmaticus may be agitated, confused, be unable to talk in complete sentences, be unable to focus, or even have a bluish tint to their lips. All these signs can be indicative of respiratory failure.

Myth 2: Pet allergies aren’t classified as allergic rhinitis.

Actually, if the provider diagnoses the patient with allergic rhinitis due to pet hair or dander from a cat or dog, then you’ll turn to the J30.8- (Other allergic rhinitis) code subcategory. This subcategory requires a 5th character to specify the type of allergic rhinitis.

Scenario: An established patient presents to the clinic with complaints of runny nose, sneezing, nasal congestion, and itchy eyes. The practitioner captures the patient’s history and performs a physical examination. The patient has been diagnosed with mild persistent asthma, but recently their condition has flared up. The patient also attested to recently adopting a cat. The provider diagnosed the patient with acute exacerbation of the mild persistent asthma due to the cat hair and dander.

In this situation, you’ll also need two ICD-10-CM codes to report the diagnosis. You’ll start with J45.31 (Mild persistent asthma with (acute) exacerbation) to report the patient’s asthma flare up. Then, you’ll assign J30.81 (Allergic rhinitis due to animal (cat) (dog) hair and dander) to report the allergy to the patient’s cat.

Once again, “if there is an exacerbation, providers must identify the cause. This will require two codes: one to specify the asthma and one for the allergy or other cause of exacerbation,” Bernard reminds coders.

Condition definition: Allergic rhinitis is a condition where the patient experiences several symptoms in their nose. The condition is also known as hay fever, but patients don’t necessarily need to be exposed to hay to experience symptoms — several environmental irritants can trigger a flare up of symptoms.

Allergic rhinitis symptoms include, but are not limited to:

• Runny nose
• Red and watery eyes
• Sneeze
• Cough
• Itching

Myth 3: Perennial allergic rhinitis is caused by flowers.

Perennials are flowers that bloom every year, but perennial allergic rhinitis isn’t necessarily related to flowers. In this case, perennial refers to allergies the patient experiences throughout the entire year rather than just allergy season.

Causes of perennial allergic rhinitis include:

• Dust mites
• Cats and dogs
• Fungi or molds

Perennial allergic rhinitis is an additional synonym for J30.89 (Other allergic rhinitis), so you’ll assign the code to report the diagnosis. You’ll also assign the code when the provider documents a specific cause of the patient’s allergic rhinitis, but the ICD-10-CM code set doesn’t include a code that matches that exact condition.