READER QUESTIONS:
Specificity Matters for Asthma Dx
Published on Tue Nov 15, 2005
Question: Do we need a fifth digit when reporting an asthma diagnosis, such as 493.2?
North Carolina Subscriber
Answer: You should always report a diagnosis to the highest-possible level of specificity. Therefore, if ICD-9 makes a fifth digit available, you should include it.
ICD-9 contains four main categories to describe asthma diagnoses:
- 493.0x--Extrinsic asthma
- 493.1x--Intrinsic asthma
- 493.2x--Chronic obstructive asthma
- 493.9x--Asthma, unspecified.
The fifth digit identifies the asthma's current state:
- 0--unspecified
- 1--with status asthmaticus
- 2--with (acute) exacerbation. For patients who do not have status asthmaticus or acute exacerbation, use a fifth digit of -0.- Code 493.x0 is appropriate when the patient presents for a checkup and his asthma is controlled.
A final digit of -1- indicates that the patient has status asthmaticus, which is a medical emergency and usually treated in the emergency department.
You should assign a -2- for patients who present with asthma that is now exacerbated (in other words, something has caused the condition to flare up).
Why it matters: Without this higher level of specificity, the payer may deny your claim for lack of medical necessity.
Example: For instance, an asthma patient has an acute exacerbation that requires a nebulizer treatment (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]).
In this case, you should link 94640 to 493.x2. Reporting a 2 as the fifth digit helps the payer to understand why the patient needs the treatment. Without the final digit (or a fifth digit of 0), the payer may assume that the patient's asthma is under control, making the coded treatment unnecessary.
