Otolaryngology Coding Alert

Question: When I use 491.9 to describe a patient's bronchitis, payers often deny the code and request more information. How can I avoid this added step?

North Dakota Subscriber

Answer: You should choose a more specific ICD-9 code, if possible, instead of the unspecified chronic code that you're using (491.9, Unspecified chronic bronchitis).

Here's how: When the allergist indicates that a patient has "chronic bronchitis," ICD-9 leads you to select 491.9. To maximize space, the selections provided on the encounter form might only offer the physician nonspecific diagnoses. Your physician's documentation may actually be more specific.

You should note that the physician may render treatment for "acute exacerbations" of chronic bronchitis. The term "acute" under 491.21 (Obstructive chronic bronchitis; with [acute] exacerbation) appears in the diagnosis definition. So if the doctor sees a patient with an exacerbation of chronic bronchitis, you may bill 491.21.

If you can't find the additional information necessary to choose a specific 491.xx code, you may have to educate your practice's physicians on the terms they need to use. Physicians may not realize the exact levels of specificity ICD-9 codes can achieve.

If your doctors are not giving you enough information to choose the right diagnosis, explain that their unspecified code selections may delay and/or reduce payment.

ICD-10: When ICD-9 shifts to ICD-10, you'll begin your code search with J20.- (Acute bronchitis). Then you'll drill down to a more specific code that describes the etiology. Your ten new choices will be:

• J20.0 (Acute bronchitis due to Mycoplasma pneumoniae)
• J20.1 (Acute bronchitis due to Hemophilus influenzae)
• J20.2 (Acute bronchitis due to streptococcus)
• J20.3 (Acute bronchitis due to coxsackievirus)
• J20.4 (Acute bronchitis due to parainfluenza virus)
• J20.5 (Acute bronchitis due to respiratory syncytial virus)
• J20.6 (Acute bronchitis due to rhinovirus)
• J20.7 (Acute bronchitis due to echovirus)
• J20.8 (Acute bronchitis due to other specified organisms)
• J20.9 (Acute bronchitis, unspecified)

Note: Code family J20.x will cover all cases of acute and subacute bronchitis along with acute tracheobronchitis. However, J20.x will not include allergic bronchitis (J45.909, Unspecified asthma, uncomplicated) and all types of chronic bronchitis (J42, Unspecified chronic bronchitis; J41.0, Simple chronic bronchitis; J44.0, Chronic obstructive pulmonary disease with acute lower respiratory infection; J41.1, Mucopurulent chronic bronchitis).

Age watch: Pay attention when your family physician diagnoses bronchitis NOS (not otherwise specified). You'll still turn to J20.9 for patients below the age of 15. If the patient is above age 15, you'll report bronchitis NOS with J40 (Bronchitis, not specified as acute or chronic) instead.