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Question: I work at a family medicine practice and our providers see patients with asthma. When I鈥檓 coding asthma, the diagnosis codes want specificity. If their provider doesn鈥檛 specifically mention whether the asthma is extrinsic or intrinsic, what other clues could I look for in the documentation?

North Carolina Subscriber

Answer: Asthma may be described as extrinsic or intrinsic, depending on the cause. Extrinsic asthma includes asthma that is triggered by an allergic reaction. Intrinsic asthma does not have an allergy trigger and has myriad causes, including cold, smoke, dry air, stress, and anxiety.

When you鈥檙e looking at documentation and see that a provider wrote that a patient has asthma triggered by stress, you鈥檇 report intrinsic asthma. You can find the appropriate code for intrinsic asthma (and extrinsic as well) in the J45- (Asthma) category.

If the provider notes that the patient鈥檚 asthma is triggered by tobacco smoke, you鈥檇 look to the Use Additional guidance to include a code to identify tobacco as a cause. In this case, according to AAPC鈥檚 Codify, you鈥檇 follow the guidance to include one of these codes:

• Z77.22 (Exposure to environmental tobacco smoke)
• P96.81 (Exposure to tobacco smoke in the perinatal period)
• Z87.891 (History of tobacco dependence)
• Z57.31 (Occupational exposure to environmental tobacco smoke)
• F17.- (Tobacco dependence)
• Z72.0 (Tobacco use).

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, 星空入口