EM Coding Alert

Question: A patient presented with chronic cough, wheezing, and difficulty breathing. The pulmonologist ordered pulmonary function testing (PFT) to evaluate the patient’s lung function and lung capacity. After interpreting the results, the physician confirmed the patient’s condition as chronic obstructive pulmonary disease (COPD) with acute exacerbation and instructed the patient on home nebulizer treatment over the next several days.

How do I report this encounter?

Vermont Subscriber

Answer: You’ll need to consider National Correct Coding Initiative (NCCI) code pairs to report this encounter. Starting with the procedure, you’ll assign 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation) to report the PFT. However, if this procedure was performed as part of an evaluation and management (E/M) visit, then you’d assign the appropriate E/M visit code, too, such as 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.).

NCCI bundles 99214 into 94010. However, because the decision for PFT arose from an assessment of the patient’s acute condition, you can apply modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M code, and report both services.

Next, you’ll turn to the ICD-10-CM code set for the COPD with acute exacerbation diagnosis. You’ll assign J44.1 (Chronic obstructive pulmonary disease with (acute) exacerbation) to report the confirmed condition.