Pulmonology Coding Alert

Question: If a patient presents for the first time with symptoms of asthma, can we code this as asthma or should we report another code such as reactive airway disease or 519.1? Virginia Subscriber Answer: One of the primary principles of ICD-9 coding 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 not report any signs and/or symptoms that a patient is having until your physician confirms or rules out the suspected condition through diagnostic testing or further evaluation.

For example, a patient comes to your physician with wheezing and coughing, no fever. The patient's medical history includes viral pneumonia within the past year. The patient also has a strong family history of asthma, but he has never been diagnosed with an asthmatic condition.

The physician suspects asthma and wishes to perform diagnostic testing and monitor the patient. Until the physician can make a formal diagnosis, you should report wheezing (786.07), coughing (786.2) and family history of asthma (V17.5, Family history of certain chronic disabling diseases; asthma).

Reporting reactive airway disease (493.9x, Asthma, unspecified) or "other diseases of trachea and bronchus, not elsewhere classified" (519.1, Other diseases of trachea and bronchus, not elsewhere classified) would not be appropriate unless you have documented confirmation of these conditions from your physician. -- Answers for You be the Coder and Reader Questions were reviewed by Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia; and Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy and Critical Care at Emory University School of Medicine in Atlanta.