Otolaryngology Coding Alert

Question: I have heard varying opinions on what the exact duration of a chronic condition is and there’s not much direction in the ICD-10 guidelines. Can you explain when I should assign a code for an acute condition versus a chronic one?

Alabama Subscriber

Answer: Generally speaking, an acute condition is one where symptoms appear suddenly and worsen rapidly, while a chronic condition is one that develops gradually and worsens over an extended period of time. However, there is a large degree of variation in the time a disease must be present for something to be referred to as chronic, so a definitive timeframe will depend on who you ask.

For example, the Centers for Disease Control and Prevention (CDC) describes chronic diseases as “conditions that last one year or more and require ongoing medical attention or limit activities of daily living or both. Similarly, the AMA CPT^® guidelines for evaluation and management (E/M) coding lists a stable, chronic illness as “a problem with an expected duration of at least one year or until the death of the patient.”

On the other hand, the U.S. National Center for Health Statistics defines chronic disease as one lasting three months or more. The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) uses this same time frame of 12 or more weeks to define chronic rhinosinusitis.

Meanwhile, three conditions the American Lung Association lists as chronic include chronic obstructive pulmonary disease (COPD), chronic bronchitis, and chronic cough, the last of which is defined as “a persistent cough that lasts for at least eight weeks, and often much longer.”

This wide range of definitions makes it clear that you can’t determine acute conditions from chronic ones using time frame alone. At the end of the day, whether a condition is defined as acute or chronic comes down to your provider’s judgment. If your provider’s documentation lists acute or chronic, then that is how you will determine your code assignment.

Coding tip: While the ICD-10-CM Official Guidelines don’t specifically break down the difference between acute and chronic conditions, Section I.B.8, “Acute and Chronic Conditions,” does specify how to sequence conditions that are described as both acute (subacute) and chronic. In situations where the same condition is described as both acute and chronic, and there are different codes in the Alphabetic Index with the same indentation level, you’ll assign both codes with the acute code sequenced first.

Example: The ENT diagnoses a patient with both acute maxillary sinusitis and chronic maxillary sinusitis. You would code J01.01 (Acute recurrent maxillary sinusitis) first and J32.0 (Chronic maxillary sinusitis) second.