Pulmonology Coding Alert

Question: Do I need a fifth digit when reporting 493.xx (Asthma)?

Michigan Subscriber

Answer: You should use a fifth digit subclassification when reporting asthma diagnosis. Your claim would likely get rejected by payers as incomplete if you submit with only four digits.

How-to: Assign the fourth digit based on the asthma category:

• 493.0x -- Extrinsic asthma

• 493.1x -- Intrinsic asthma

• 493.2x -- Chronic obstructive asthma

• 493.8x -- Other forms of asthma

• 493.9x -- Asthma, unspecified.

Then, choose the asthma's current state from any of the appropriate fifth digit:

• 0 -- unspecified

• 1 -- with status asthmaticus

• 2 -- with (acute) exacerbation.

Clue: Code 493.x0 when the patient's asthma is controlled. A fifth digit of "1" means the patient has status asthmaticus, a medical emergency that is usually treated in the ER. You should assign a "2" when something has caused the condition to exacerbate.

Important: The fifth digit is for the purpose of accuracy, without which payers may deny your claim for lack of medical necessity.