Pulmonology Coding Alert

Hint: 94010, 94375 are shoe-ins for bundled status A workup for possible extrinsic allergic alveolitis doesn't have to leave you short of breath. Follow these steps to sort out which codes you should bill and which you should omit.

When a patient has a type III allergic reaction to environmental allergens and develops local inflammation that causes tissue damage, the pulmonologist should diagnose the patient as having a common occupational antigen disease -- hypersensitivity pneumonitis, an inflammatory lung disorder that is often referred to as extrinsic allergic alveolitis (EAA).

The steps that a pulmonologist must take to properly diagnose this disease, however, can lead to complicated coding issues. Several tests that the pulmonologist may order can be useful in diagnosing EAA. See if you can solve this coding conundrum: 

To test a patient for EAA (495.x), a pulmonologist orders several pulmonary function tests (PFTs), including spirometry (94010), flow volume loop (94375), lung volume (94240), diffusing capacity (94720), and pulse oximetry (94760). He also orders an antigen challenge test (94070, 95071) and a blood workup (86001, 85025). Should I separately report the tests, or are some bundled into each other? Step 1: Report Performed E/M Service You should code for the appropriate level of E/M care documented, if provided. Taking into account the in-depth history, examination and level of medical decision-making involved in working up a possible diagnosis of hypersensitivity pneumonitis or EAA, "if documented correctly a higher-level office visit (such as 99204 or 99214, Office or other outpatient visit ...) may be warranted for this extensive work," says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.

Remember: You cannot bill pulse oximetry (94760) on the same day that you bill a physician-performed E/M service -- 94760 would be bundled into the E/M service. Step 2: Let Lab Code for Its Work You cannot bill for the laboratory tests (86001, 85025) "unless your office is certified to process and analyze the specimens," Pohlig says. But in addition to the E/M visit (e.g., 99204 or 99214), you can report some of the other tests, such as:

• the postexposure evaluation (94070, Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents [e.g., antigen(s), cold air, methacholine])

• antigen challenge testing (95071, Inhalation bronchial challenge testing [not including necessary pulmonary function tests]; with antigens or gases, specify)

• lung volume (94240, Functional residual capacity or residual volume: helium method, nitrogen open circuit method, or other method)

• diffusing capacity (94720, Carbon monoxide diffusing capacity [e.g., single breath, steady state]).

Step 3: Check Site Before Billing PF Tests
 
If the pulmonologist saw the patient in the outpatient portion of the hospital and the prolonged postexposure evaluation (94070) and [...]