Primary Care Coding Alert

Question: A patient with extrinsic asthma reports to the hospital in the throes of a severe asthma attack. While providing critical care services to the patient, the FP diagnoses the patient with status asthmaticus. Total critical care time is 37 minutes. On the claim, I reported 99291 with 493.00 as a diagnosis and received a denial. What did I do wrong?

Kentucky Subscriber

Answer: Your diagnosis coding was slightly off, which likely led to the denial. On your claim, you submitted 493.00 (Extrinsic asthma; unspecified) as the ICD-9 code. However, you should have chosen 493.01 (- with status asthmaticus) instead.

Explanation: Patients sometimes require critical care services if they have asthma with status asthmaticus; reporting 493.01 as the diagnosis informs the payer of the patient's condition, while 493.00 does not specify the patient's status asthmaticus.

When you re-submit the claim, report the following:

- 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the critical care

- 493.01 linked to 99291 to represent the patient's extrinsic asthma with status asthmaticus.

-- Answers to You Be the Coder and Reader Questions reviewed by Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.