ED Coding and Reimbursement Alert

Question: The ED physician treats a patient with shortness of breath and coughing. The ED physician performs a level-three E/M, then orders a spirometry. Based on test results, the physician diagnoses chronic obstructive pulmonary disease (COPD) with acute bronchitis. I reported 94010 and 99283, and the insurer rejected the spirometry code. What did I do wrong?

Connecticut Subscriber

Answer: A spirometry is not separately billable by the ED physician. You cannot report 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) for this encounter.

In the future, see if you can roll the spirometry work into the overall E/M level. There is a chance you could increase the overall service level.

Benefit: If the ED physician performed enough work to increase the overall service level in your example, you would have been able to report 99284 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a detailed history; a detailed examination; and medical decision making of moderate complexity ...) for the service instead of 99283 ( - an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity ...)

ICD-9 coding: When a patient has COPD along with bronchitis, be sure to choose a single diagnosis code to represent both conditions: 491.22 (Obstructive chronic bronchitis with acute bronchitis).

Note: You don't have to report 466.0 (Acute bronchitis) for the obstructive chronic bronchitis because the code descriptor for 491.22 specifies acute bronchitis.