Otolaryngology Coding Alert

If you're submitting CPT codes with three-digit diagnosis codes linked to them - such as 493 for the asthma group - you'd better be sure that the claim is correct, because more payers than ever before are demanding accurate ICD-9 coding.
 
In fact, diagnosis coding is evolving from a choice to a necessity when filing with some carriers - because they are rejecting claims as "medically unnecessary" at a higher rate than they did a few years ago.

Payers Looking at ICD-9 Codes on Claims

Before sending out a claim with a three-digit diagnosis code, you should double-check the code, says Victoria Jackson, owner of Omni Management, which provides practice management services for 15 medical offices in the Los Angeles area. Jackson contends that three-digit diagnosis codes raise the eyebrows of payers because there are very few ICD-9 codes that aren't at least four digits, and all insurance carriers are getting more careful when it comes to diagnosis coding.
 
"A lot of us didn't pay attention to ICD-9 coding in the past because Medicare was the only carrier that cared if you used the codes," Jackson says. Now, all insurance companies are looking for ICD-9 codes, so coders have to make sure the diagnoses are correctly represented on claims.

Take the 2-Question Test

To ensure accurate ICD-9 reporting, Margaret Lamb, RHIT, CPC, coding expert in Great Falls, Mont., asks herself two questions before sending out a claim:
 1. Do I have a complete code?
 2. Do I have the most specific complete code?
 
Always report the ICD-9 code that provides the highest degree of accuracy and completeness. " 'Highest degree' means that you should assign the most precise ICD-9 code that most fully explains the narrative description of the symptom or diagnosis," says JoAnn Baker, CCS, CPC-H, CPC, CHCC, an education specialist in East Orange, N.J.

2 Tips to Accurate Asthma Coding

Jackson takes two steps to code as specifically as possible for a patient with asthma.
 
Step 1: Find the base code for asthma. The asthma listing in ICD-9 (493) has a "4th" box beside it, meaning you must carry this diagnosis code to at least the fourth digit.
 
Step 2: Check four-digit code options. All of the four-digit code options for asthma - 493.0 (Extrinsic asthma), 493.1 (Intrinsic asthma), 493.2 (Chronic obstructive asthma), 493.8 (Other forms of asthma) and 493.9 (Asthma, unspecified) - have "5th" boxes beside them.
 
Don't ignore the box - it's there for a reason. Asthma coding is "an instance where you should use the fifth digit or you may not get paid," Jackson says.