Pulmonology Coding Alert

Question: An established patient with a history of asthma who is now taking Albuterol presents with a barking cough. The pulmonologist performs a level-three evaluation and management service, notes a “croupy-sounding cough” and gives a final diagnosis of asthma. In this scenario, which ICD-9 code (or codes) should I report?


Michigan Subscriber  
Answer: You should choose a diagnosis code that reflects the patient’s asthma and the croupy sounds. ICD-9 contains a diagnosis code that represents both. When you look up “Croup” in the ICD-9 index, it instructs you to use 493.9x for asthmatic croup. So on the claim you should:

--report 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...) for the E/M service

--link 493.90 (Asthma, unspecified; unspecified) to 99213 to represent the patient’s asthma and croup.   Answers to You Be the Coder and Reader Questions answered/reviewed by Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta; Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia; and Jill Young, CPC, an AAPC National Advisory Board member and president of Young Medical Consulting in East Lansing, Mich.