Coding Consult

March 17, 2006

Answers to your questions about...hospital readmission; asthma diagnosis codes; dermabond repair

Hospital readmission

Q. I discharged a patient from the hospital and had to readmit him the next day. Should I code for the second admission service?

Asthma diagnosis codes

Q. When reporting an asthma diagnosis, do I need a fifth digit?

A. Yes. If you submit four digits for an asthma diagnosis (493.xx), payers will probably reject the ICD-9 code as incomplete.

Correct method: First, assign the fourth digit based on the asthma category:

Without this higher level of specificity, the payer may deny your claim for lack of medical necessity. For example, an extrinsic asthma patient has an acute exacerbation that requires a nebulizer treatment (94640, pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]). In this case, you should link 94640 to 493.02. Reporting a "2" as the fifth digit helps the payer to understand why the patient needs the treatment.

Dermabond repair

Q. I closed a 68-year-old female's 2-centimeter superficial thigh wound using Dermabond. How should I code the repair?

A. Because you performed the simple laceration repair using only Dermabond on a Medicare patient, you should code the procedure with G0168 (wound closure utilizing tissue adhesive[s] only).

If the patient had a private insurer, you would instead assign the corresponding CPT code 12001 for simple laceration repair (simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less]).

This information is adapted from material provided by the Coding Institute. For a free sample issue or information on how to subscribe to any of 29 specialty-specific coding newsletters, please contact the Coding Institute, 2272 Airport Road South, Naples, FL 34112; phone 800-508-2582; fax 800-508-2592 or visit http://www.codinginstitute.com.