Pulmonology Coding Alert

Hint: Some tests will be bundled.

If you see patients with extrinsic allergic alveolitis -- also referred to as hypersensitivity pneumonitis – you’re probably surprised at the number of coding options that come into play for each visit. Check out a few common mistakes surrounding this diagnosis and evaluate the right way to report the encounters so you don’t face denials.

Example: A patient presents with fever, muscle aches, dry cough, shortness of breath, and a general feeling of being unwell. Although these symptoms could lead your pulmonologist to report extrinsic allergic alveolitis (J67.x), it may not be the appropriate ICD-10 code unless a definitive diagnosis is determined. Digging deeper than the tip of the iceberg means your physician should take several steps to properly diagnose this condition, but the whole process could leave you dazed and confused.

Check out the following common mistakes that surround this diagnosis and ensure that you don’t make any of them when you see these patients.

Mistake 1: You Overlook E/M Encounter

Extrinsic allergic alveolitis (J67.x) is a lung disorder resulting from repeated inhalation of organic dust, usually in a specific occupational setting. In diagnosis, the best evidence for this condition is the patient’s occupation and a history of exposure to animal or vegetable dusts.

The physician often performs testing to verify the diagnosis, including spirometry, flow volume loop, lung volume, diffusing capacity, and pulse oximetry, antigen challenge test, and blood testing. With this many codes involved, how should you determine which should be reported?

Hold that thought:  Before you even consider reporting these tests, chances are your pulmonologist would have initially performed an E/M service. If the doctor’s notes indicated that he or she performed this service, then you should bill the appropriate level of E/M care (99201-99215).

Mistake #2: You Charge All Tests For The Provider

Besides the E/M code, you may report some of the tests that the pulmonologist may have ordered, including:

• 94070 -- Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (eg, antigen[s], cold air, methacholine)
• 95071 -- Inhalation bronchial challenge testing (not including necessary pulmonary function tests); with antigens or gases, specify 

Watch out: Use caution when reporting laboratory test such as 86001 (Allergen specific IgG quantitative or semiquantitative, each allergen). You can bill this service only if your office is certified to process and analyze the specimens.

Keep in mind: Although some of the other tests may be billable with the E/M, reporting pulse oximetry (94760, Noninvasive ear or pulse oximetry for oxygen saturation; single determination) on the same day as any other billable service would be a no-no since the 94760 “T-status” bundles the corresponding payment into all other same-day payments.

Mistake #3: CCI Bundles Get Past Your Radar

If the pulmonologist orders both spirometry (94010, Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) and flow volume loop (94375, Respiratory flow volume loop) as diagnostic tests, you’ll have to leave 94375 off your claim.

Why: Code 94375 is a column two code for 94010 and the indicator is “0,” which means you cannot bill these codes together under any circumstances. Non-Medicare insurance carriers may allow payment but, you should check with payers first about their policy.

If your pulmonologist reports other tests together, always check CCI edits to see what you can report together and which codes must be appended with a modifier or left off your claim entirely.