Pediatric Coding Alert

Question: Would you please help me with the coding of 461.9 (Acute sinusitis, unspecified)? United HealthCare denied it as needing a fifth digit. But the 2006-07 book of changes does not indicate a fifth-digit subclassification for 461.9. Has this code changed, and do I need a fifth digit?


Florida Subscriber

Answer: You're correct that 461.9 doesn't require a fifth digit. Because ICD-9 expands many four-digit codes into five digits each year, some insurers now incorrectly think all diagnostic codes require five digits.

Try this: Respond to incomplete-code denials for 461.9 with a copy of the page from your ICD-9 manual. Circle ICD-9's 461.9 directive that shows the code only requires a fourth digit.