Primary Care Coding Alert

Question: When I use 491.9, payers often deny the code and request additional information. How can I avoid this added step?


Pennsylvania Subscriber

Answer: Choose a more specific ICD-9 code instead of the unspecified code (491.9, Unspecified chronic bronchitis) that you-re now using. If the family physician is circling 491.9, rather than a more specific diagnosis, look at his documentation for additional information.

Here's how: When the physician specifically identifies that a patient has -acute exacerbation,- you should assign 491.21 (Obstructive chronic bronchitis; with [acute] exacerbation). If you find the phrase -without exacerbation,- report 491.20 (... without exacerbation). Both of these ICD-9 codes represent specific obstructive chronic bronchitis diagnoses.

If you can't find the additional information necessary to choose a specific 491.2x code, you may have to educate the FP on the terms he needs to use. Explain that his unspecified code selection and/or lack of information is delaying payment.

Answers to You Be the Coder and Reader Questions answered by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions in Tinton Falls, N.J.; and Victoria S. Jackson, practice management consultant with JCM Inc. in California.