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Family Practice Coding Alert


Clue In to Asthma Fifth Digits

Question: Would you code documentation that states, -acute status asthmaticus- as status asthmaticus or with (acute) exacerbation?

New York Subscriber 

Answer: Your family physician probably meant -status asthmaticus,- but you should double-check the doctor's intention because -acute- and -status- describe different conditions. The rest of the notes and the E/M code can also point you to the correct fifth-digit subclassification to use with 493.xx (Asthma).

You should use a fifth digit of -1- for asthma with status asthmaticus, such as 493.01 (Extrinsic asthma with status asthmaticus). Status asthmaticus defines a severe and prolonged asthma attack. So the term implies a severity rating and a duration definition.

Status asthmaticus is life-threatening and implies inpatient intensive care for treatment. Therefore, you will usually use 493.x1 with an inpatient admission code (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient -) and possibly also a critical care code (99291-99292, Critical care, evaluation and management of the critically ill or critically injured patient -).
Fallback position: If the FP selected an outpatient E/M code, such as 99214-99215 (Office or other outpatient visit for the evaluation and management of an established patient -), and the patient went home after treatment, you should instead assign a fifth digit of -2- to indicate asthma with (acute) exacerbation.

Acute exacerbation means a patient has developed worsening symptoms that have just happened. The term does not provide any severity information. A patient could go from no symptoms to just a little cough, yet the physician could still define the condition as acute exacerbation.

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