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Coding conditions as "acute" versus "chronic"

HIM Connection, September 29, 2009

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Question: A patient came into the ER with complaints of a headache and facial pain. The ER physician gave a final diagnosis of sinusitis. This patient had no history of sinusitis. After a coding review, the reviewer said we were wrong to use “acute” and told us to use “chronic.” She told us never to use “acute” unless the physician documents the condition as “acute.” We were previously under the impression that when coding ER accounts, coders should always report conditions as “acute.” Do you know of any ER coding guidelines or publications that would clear this up?

ANSWER: Coders assign codes based on physician documentation. In order to assign a code for an acute condition, the coder should see clearly that the physician documented it as acute. Many ICD-9-CM codes, like sinusitis, default to a chronic status without further specification by the physician.

    Sinusitis (accessory) (nasal) (hyperplastic) (nonpurulent) (purulent) (chronic)     473.9

Coders should not assign codes based on the setting in which the physician provided the services. Patients could present to the ER for care related to a chronic condition as well as an acute condition.  

Editor’s note: Shannon McCall, RHIA, CCS, CCS-P, CPC-I, CCDS, director of HIM and coding for HCPro, Inc., in Marblehead, MA answered this question in the October issue of Briefings on Coding Compliance Strategies.

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