Relying on the physician’s encounter form could be a big mistake.
Question: I used 491.9 to report a patient’s bronchitis, but the payer denied my claim and requested additional information. What was wrong?
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 physician’s encounter form, which usually lists nonspecific diagnoses to maximize space. Your physician’s documentation may actually be more specific.
For instance, your physician 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 physician sees a patient with an exacerbation of chronic bronchitis, you may report 491.21.
Snag: You may find your doctor 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.
Smart: 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.
Want to be ahead of the game? Attend the ICD-10 Issues: Get Ready for the Conversion ASAP audio conference.
Also, when’s the last time you tuned up your internal auditing process? Check out this upcoming Jacqueline Stack audio conference: Do Your Own Auditing – Spot Problems Without Outsourcing.
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