Pulmonology Coding Alert

Question: My allergist's notes state, "A history of asthma-induced bronchitis." Does this mean I should report an asthma code for bronchitis?

Idaho Subscriber

Answer: Code 466.0 (Acute bronchitis) may be your primary -- and possibly only -- diagnosis, if it best describes the acute condition being treated. If the patient has asthma with acute bronchitis, then code 493.02 for allergic asthma with acute bronchitis or 493.12 for intrinsic asthma with acute bronchitis. If the asthma is not that well defined, use 493.92. Try not to use an unspecified asthma code (493.9x, 493.x0) if you can avoid it.

Why: Some insurers will deny unspecified asthma code 493.9x. Depending on the service you are reporting and whether the payer accepts the code, you may have to submit additional notes and ultimately have to select a specific code. Before filing the claim, get the information you need to avoid using an unspecified code.

Refer to the physician's notes or ask your pulmonologist for more information. If the pulmonologist simply mentions that the patient has a history of asthma, you may want to reconsider reporting 493.92 and report 466.0 for the acute bronchitis.

Your code choice partly depends on the place of service:

Inpatient: In this case, code the secondary diagnosis because you need as many comorbidity ICD-9 codes as possible to support the assigned E/M level in a facility setting.

Outpatient: Look at whether the visit addressesthe asthma. If the patient's asthma is not causing any problems, the condition may not warrant using an asthma ICD-9 code. But if the condition affects the plan of care (for instance, the patient's asthma medication impacts the bronchitis treatment), report the condition.

-- The answers to Reader Questions and You Be the Coder were provided and reviewed by Alan L. Plummer, MD, professor of medicine in the division of pulmonary, allergy, and critical care at Emory University School of Medicine in Atlanta; and Carol Pohlig, BSN, RN, CPC, ASC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.