Pulmonology Coding Alert

Alleviate pet dander,chronic bronchitis with 2 new codes

It's official: The Centers for Disease Control and CMS unveiled their new 2005 ICD-9 codes with two new codes for allergic rhinitis (477.2) and chronic bronchitis (491.22) that will make your diagnosis coding more specific and improve your reimbursement for these conditions.

Before Oct. 1, you'll have to add 477.2 (Allergic rhinitis, due to animal [cat] [dog] hair and dander) and 491.22 (Obstructive chronic bronchitis with acute bronchitis) to your respiratory ICD-9 codes.

When animal (cat, dog, etc.) hair and dander cause allergic rhinitis, coders should now report ICD code 477.2. The addition of 477.2 to ICD-9 allows for greater specificity as to the cause of the allergic rhinitis cases you report, says Roger Hettinger, CPC, CMC, CCS-P, coding specialist at Sioux Valley Clinic in Sioux Falls, S.D.

Old way: Before the addition of this code, no code existed specifically for allergic rhinitis due to animal hair and dander, so you would report code 477.8 (Allergic rhinitis; due to other allergen) if the patient appeared with allergic symptoms for animals, Hettinger says. This code should bring you more accurate reporting for rhinitis and allow you to bill the most appropriate code when animals are the cause of your patients'sniffles and sneezes.

Extra: You can now add 477.2 to the ICD-9 codes that already existed for rhinitis, such as 477.0 (Allergic rhinitis; due to pollen), 477.1 (... due to food), 477.8 (... due to other allergen), and 477.9 (... cause unspecified).

You should use 491.0 (Simple chronic bronchitis) to code for chronic bronchitis due to smoking or for a smoker's cough, advises Alan L. Plummer, MD, professor of medicine in the division of pulmonary, allergy and critical care at the Emory University School of Medicine in Atlanta. You should use 491.1 (Mucopurulent chronic bronchitis) to code for a patient who chronically produces purulent or mucopurulent mucous, Plummer says.

Exception: If the patient has chronic bronchitis and airflow obstruction, you should choose from the 491.2x series (Obstructive chronic bronchitis) since these codes require five digits, Plummer says. For example, report 491.20 (Obstructive chronic bronchitis; without exacerbation) if the patient is stable. If the patient has an acute exacerbation that is not due to acute bronchitis, use 491.21 (Obstructive chronic bronchitis; with [acute] exacerbation).

The new code: If the patient develops yellow mucous acutely, which appears to be due to an infection, Plummer says to use the new ICD-9 code, 491.22, to report obstructive bronchitis with acute bronchitis. "It may be difficult to differentiate between an acute decompensation due to infection and another cause (such as air pollution) in a patient with chronic obstructive bronchitis, but the new code 491.22 allows you to make that distinction," he says.

Old way: Prior to the new code, you would report 491.21 for a patient with chronic obstructive bronchitis who developed acute bronchitis. In the past, reporting 491.21 did not allow you to individualize specification for chronic bronchitis because this condition was grouped with other similar but different conditions, such as acute bronchitis with chronic obstructive pulmonary disease, acute exacerbation of chronic obstructive pulmonary disease, and emphysema with both acute and chronic bronchitis, Plummer says.

Now, with the addition of 491.22, your practice can take advantage of the new level of specificity and collect full pay for appropriate billing.

To review a full listing of the new ICD-9 codes, visit the CMS Web site http://www.cms.hhs.gov/medlearn/icd9code.asp#coding.