Pulmonology Coding Alert

Question: A pediatric patient with symptoms of asthma comes to our practice for the first time. Our physician believes that if it is the first time a patient has asthmatic symptoms, we should code reactive airway disease with ICD-9 code 519.1 (Other diseases of trachea and bronchus, not elsewhere classified). Our physician also believes that we cannot code asthma until the patient presents with asthmatic symptoms a second time or when the physician confirms an asthma diagnosis from the results of additional tests. Should I code asthma for this pediatric patient?

Maryland Subscriber

Answer: The ICD-9 manual defines reactive airway disease as "asthma," which suggests that the physician diagnosed the patient and confirmed a "disease or condition" of the trachea or bronchus. You should not report reactive airway disease (493.9x, Asthma, unspecified) or 519.1 (Other diseases of trachea and bronchus, not elsewhere classified) in your case unless you have the documentation to confirm these conditions from your physician.    

One of the primary principles of ICD-9 coding that you should follow is to code only definitive conditions. If you consider a condition as "probable," "possible," "suspected" or "rule out," don't report that condition. 

You should report any signs and/or symptoms that a patient has until your physician confirms or rules out the suspected condition using diagnostic testing or further evaluation. 

For example, the pediatric patient you describe may present symptoms of wheezing and coughing without a fever. The patient's medical history includes viral pneumonia within the past year. The patient also has a strong family history of asthma, but no physician has ever diagnosed him with the condition.

The physician may suspect asthma and decide to perform diagnostic tests to monitor the patient. Until the physician makes a formal diagnosis, you should report only wheezing (786.07, Wheezing), coughing (786.2, Cough), and family history of asthma (V17.5, Family history of certain chronic disabling diseases; asthma).