Pediatric Coding Alert

Reviewed on May 11, 2015

The problem is with the term, not the code

If you’re struggling to find an ICD-9 code for RAD, a better way exists.

See if your reactive airway disease (RAD) coding is up to par. A recent request for how to code a diagnosis of RAD resulted in six suggestions. Which would you choose?

a. 493.90 -- Asthma, unspecified; unspecified

b.   519.1 -- Other diseases of trachea and bronchus, not elsewhere classified

c. 519.11 -- Acute bronchospasm

d.  519.8 -- Other diseases of respiratory system, not elsewhere classified

e.  519.9 -- Unspecified disease of respiratory system

f.  786.07 -- Wheezing.

Answer: A. 493.90 for asthma unspecified without exacerbation or status. But before you footnote RAD on your coding hot sheet as 493.90, find out why experts shun this term -- and why 786.07 might be an alternative.

Equate RAD With Asthma

Part of the problem with coding for RAD is that ICD-9 does not contain the term in its alphabetical listing. “RAD is a clinical term, not an ICD-9 term,” says Vicky O’Neil, CPC, CSS-P, president of The Hazlett Group in St. Louis.

Although ICD doesn’t specifically direct you to 493.90 for RAD, “ICD-9 considers RAD and asthma as the same diagnosis,” says Jeffrey F. Linzer Sr., MD, FAAP, FACEP, associate medical director for compliance and business affairs at EPG in Egleston, Ga.The ICD-10 manual also says “See asthma” when you look up “Reactive airway disease” in the alphabetical index. Code 493.90 crosswalks to J45.909, Unspecified asthma, uncomplicated.

Do this: If the pediatrician writes “RAD” as the diagnosis, you should use the appropriate code from the 493 category, Linzer says. If you’re unclear about which code to use, you should ask the physician, he adds.

Encourage Calling Asthma Asthma

Some experts advise eliminating the diagnosis from your repertoire. “Reactive Airway Disease: A lazy term of uncertain meaning that should be abandoned” appeared in the March 2001 American Journal of Respiratory and Critical Care Medicine by Drs. John V. Fahy and Paul M. O’Byrne.

Doctors don’t like RAD “because it’s a sloppy term,” says Miles Wienberger, MD, in the CME Masters of Pediatrics lecture “Treatment of Viral Infection-Induced Asthma in Young Children,” sponsored by the University of Miami School of Medicine. Example: A patient comes in and requires bronchodilators (such as 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]). So the physician says the patient has RAD. “But I often say that ‘reactive airway disease’ is a term used by people with a speech defect; they have a problem saying the word ‘asthma,’ ” he says.

Try Options for Undetermined Asthma

Give your pediatricians the heads-up that if they’re using RAD absent a definitive diagnosis of asthma, alternatives exist. Weinberger, who is professor of pediatrics and director of the pediatric allergy and pulmonary division at the University of Iowa, recommends that pediatricians:

1. take a better history.

2. determine if the patient has some other underlying problem or if, in fact, it is asthma. Remember: Physicians should use standardized guidelines (such as the NHLBI Expert Panel Report) in making or deferring the asthma diagnosis.

Option 3: The physician can always use a symptom- or complaint-based diagnosis, such as wheezing (786.07) or shortness of breath (786.05), Linzer says.Under ICD-10, you’ll report R06.2, Wheezing, or R06.02, Shortness of breath, as appropriate.

Never Replace RAD With 519.11

Don’t equate RAD with the ICD-9 2007-introduced code 519.11 (Acute bronchospasm) or ICD-10 code J98.01 (Acute bronchospasm). This code specifies those situations in which the patient has bronchospasm but has not been diagnosed with asthma, Linzer says.

Pride Yourself on This Catch

You deserve a pat on the back if you pinpointed one ICD-9 code in the above list that would never be correct. Code 519.1 is no longer an acceptable code because that section now requires a fifth digit, Linzer says.