Pulmonology Coding Alert

Question: When I use 491.9 to describe a patient's bronchitis, payers often deny the code and request additional information. How can I avoid this added step?


North Dakota Subscriber

Answer: You should choose a more specific ICD-9 code, if possible, instead of the unspecified chronic code that you're using (491.9, Unspecified chronic bronchitis).

Here's how: When the pulmonologist indicates that a patient has "chronic bronchitis," ICD-9 leads you to select 491.9. To maximize space, the selections provided on the encounter form might only offer the physician nonspecific diagnoses. Your pulmonologist's documentation may actually be more specific.

You should note that the physician may render treatment for "acute exacerbations" of chronic bronchitis. The term "acute" under 491.21 (Obstructive chronic bronchitis; with [acute] exacerbation) appears in the diagnosis definition. Therefore, if the pulmonologist sees a patient with an exacerbation of chronic bronchitis, you may report 491.21. 

If you can't find the additional information necessary to choose a specific 491.xx code, you may have to educate your practice's pulmonologists on the terms they need to use. Physicians may not realize the exact levels of specificity ICD-9 codes can achieve.

If your pulmonologists are not giving you enough information to choose the right diagnosis, explain that their unspecified code selections may delay and/or reduce payment. 

Answers to You Be the Coder and Reader Questions reviewed by  Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta; Carol Pohlig, BSN, RN, CPC, at the University of Pennsylvania in Philadelphia.