Pulmonology Coding Alert

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


North Dakota Subscriber

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

Here's how: When the physician 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 may only offer the physician non-specific diagnoses. The documented diagnosis may be more specific.

As an example, you may find the phrase "obstructive chronic bronchitis with acute bronchitis," for which you should report 491.22 (Chronic bronchitis; with acute bronchitis), or "smokers' cough," for which you should report 491.0 (Simple chronic bronchitis). Both of these ICD-9 codes represent more specific obstructive chronic bronchitis diagnoses.

If you can't find the additional information necessary to choose a specific 491.xx code, you may have to educate your pulmonologist on the terms he needs to use. Physicians may not realize the level of specificity ICD-9 codes can achieve. Explain that his unspecified code selection and/or lack of information may delay payment.

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.