Otolaryngology Coding Alert

Ensure proper payment with these ICD-9 coding strategies

CMS made your asthma-related diagnosis coding easier this year by introducing ICD-9 codes 493.81 and 493.82, which allow you to specify the asthma problem, instead of relying on the patient's signs and symptoms. 
 
Medicare focused on asthma for many of its 2004 updates because the disease is a high-profile condition for patients, physicians and payers, says Anthony M. Marinelli, MD, FCCP, chairman of the American Thoracic Society's Clinical Practice Committee. CMS and other carriers may use the data from ICD-9 reports to adjust payments or develop quality guidelines. That's why your practice should be as accurate as possible when you report diagnosis codes to avoid potential fraud or abuse, he adds.

Watch Your Signs and Symptoms Coding

Having 493.81 (Exercise-induced bronchospasm) and 493.82 (Cough-variant asthma) means that your allergist's documentation can medically justify with more specificity his asthma treatment procedures. But it also means that if you are still using signs and symptoms coding, your insurer may deny your claims or the coding practice could trigger an audit, says Mary Mulholland, BSN, RN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania's department of medicine in Philadelphia. 

"When selecting the primary diagnosis code, the coder should first report the ICD-9 diagnosis that most accurately identifies the patient's medical condition," Mulholland says. Coders may also report any additional signs and symptoms, which the physician documents in the medical record, if they contribute to the doctor's services, she adds.

Example: When a patient presents with chronic cough (786.2) and shortness of breath (786.05), your allergist may test for cough-variant asthma. Suppose the physician tests the patient with bronchodilators (94640, Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]) and diagnoses the patient with cough-variant asthma.

In this situation, you would bill 94640 for the bronchodilator treatment and link 493.82 to 94640. Make sure the physician's documentation specifies cough-variant asthma, not only the signs and symptoms (786.2 and 786.05). Prior to this year, you could have used 786.2 and 786.05 to justify billing 94640, but now Medicare and most private insurers require 493.82, which is the most specific code.

Use New V Codes for Inoculations

You should report a five-digit diagnosis code when patients need inoculations for compromised immune systems. Codes V04.81 (Need for prophylactic vaccination and inoculation against certain viral diseases; influenza), V04.82 (... respiratory syncytial virus [RSV]) and V04.89 (... other viral diseases) replace V04.8 (Need for prophylactic vaccination and inoculation against certain viral diseases, influenza).

Watch for: The physician should use V04.81, V04.82 and V04.89 only for vaccinations, Marinelli says. For example, if your allergist vaccinated a patient vulnerable to influenza (487.x), you would report G0008 (Administration of influenza virus vaccine ...) for Medicare patients or 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections]; one vaccine [single or combination vaccine/toxoid]) for most private insurers. You would link the diagnosis V04.81 to the procedure.