Pulmonology Coding Alert

Question: I used 491.9 to report a patient's bronchitis, but the payer denied my claim and requested additional information. What was wrong?

Vermont Subscriber

Answer: Your claim may have been denied because you chose an unspecified chronic bronchitis code (491.9, Unspecified chronic bronchitis) instead of a more specific ICD-9 code.

Here's how to avoid "diagnosis coding" denials next time: Don't rely on the pulmonologist's encounter form, which usually lists nonspecific diagnoses to maximize space. Your pulmonologist's documentation may actually be more specific.

For instance, the pulmonologist has recorded that treatment for an "acute exacerbation" of chronic bronchitis was provided. 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.

Snag: You may find your pulmonologist unaware that proper documentation is critical. You should suggest  that the pulmonologist be more specific on the terms and descriptions used in the chart when appropriate, and that, without proper documentation, unspecified codes may delay and/or reduce payment.

Note: ICD-10-CM will prompt you for more specified coding. It's important to incorporate specificity into your coding and documentation -- as early as now. AAPC lists J44.1 (Chronic obstructive pulmonary disease with [acute] exacerbation) as the replacement of ICD-9 code 491.21 when the system transitions to ICD-10-CM.