493.2x can be confusing in the absence of proper documentation

493.2x can be confusing in the absence of proper documentation

When a patient presents to the pulmonologist with asthma or bronchitis, and symptoms of chronic obstructive pulmonary disease (COPD), your physician's notes may be your best bet.

Having the right information ready before referring to your ICD-9 manual could also save you from unnecessary trouble. First, ensure that the documentation supports the physician's diagnosis. After that, be on the lookout for associated acute conditions.

When you are faced with the situation, ask these three important questions that can help you breathe easily through your lung diagnosis coding.

Do you see any sign of COPD-associated asthma?

If a pulmonologist diagnosed a patient with both asthma and COPD, you should go to the 493.x section of ICD-9 and select from the three options:

493.20 -- Chronic obstructive asthma; unspecified

493.21 -- Chronic obstructive asthma; with status asthmaticus

493.22 -- Chronic obstructive asthma; with (acute) exacerbation. Some players treat 493.20 as default codes. It is always safe to check with your pulmonologist first to see if the patient has status asthmaticus or acute exacerbation before settling with 493.20. Does the MD diagnose COPD along with bronchitis? When your pulmonolist documents chronic obstructive bronchitis with an episode of acute bronchitis, you should report 491.22. Reporting 466.0 (Acute bronchitis) for the obstructive chronic bronchitis is wrong as 466.0 fails to capture the patient complexity of an acute-on-chronic illness, as in 491.22. Did you get in-depth documentation from the pulmonologist? If you are coding COPD, full details are important. See to it that the documentation includes a listing of signs, symptoms, and conditions. A simple entry of shortness of breath and cough may not be enough. Many cardiopulmonary diseases manifest themselves in this fashion; as such, the symptoms can represent a progression of chronic illness or other acute issues, either related or unrelated to the patient's chronic disease. So these clinical evaluation, based on a detailed history is very important. To decide on a new illness or a progressing/ exacerbating chronic illness, the doctor may order blood studies along with radiographical and physiological evaluations. Just listing COPD as the diagnosis doesn't reflect the patient's present status. Including the signs, symptoms, or the exacerbation will help in justifying the medical necessity of the studies ordered. For more Pulmonology coding tips, tune in to an audio conference.

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