Pulmonology Coding Alert

Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis (491.9) and emphysema (492.8) characterized by irreversible airflow obstruction. As much as 10 percent of the population more than 65 years of age are estimated to have COPD, and the number of cases grows as the population ages.

Pulmonologists document COPD patient records with various patient-reported symptoms, tests, diagnoses and treatments, including the following.

Coding Spirometry

Spirometry (94010-94070) is the recommended test for COPD. Use 94010 (spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) to indicate repeat spirometries performed to evaluate a patients response to newly established treatments, to monitor the course of COPD, or to evaluate a patient continuing with symptoms after initiation of treatment.

Proper documentation for this procedure should include:

The medical necessity of these tests, such as diagnosis codes, must be submitted on all claims.

All providers of pulmonary function tests should have on file a referral (a prescription) with clinical diagnoses and requested tests. Indications for the studies should be described clearly in the clinical records and available for review.

All equipment and studies should meet minimum standards outlined by the American Thoracic Society (see Standardization of Spirometry at www.thoracic.org/statementframe.html).

Spirometry studies, in particular, require a minimum of three attempts that must meet minimum acceptability criteria.

All studies require an interpretation with a written report. Computerized reports must have a physicians signature attesting to its accuracy.

Multiple Tests Means Multiple Codes

Pulmonologists often must perform multiple tests before making a definitive diagnosis if the patient presents with complex problems. For example, if a patient reports shortness of breath (786.05), wheezing (786.07) and breathlessness (786.09) after exertion, your pulmonologist could order the spirometry.

The test results are normal, but the patients condition remains unchanged. The cause of the patients complaint must still be determined, so the patient undergoes a simple pulmonary stress test (94620, pulmonary stress testing; simple [e.g., prolonged exercise test for bronchospasm with pre- and post-spirometry]). Because both tests are needed, your practice could bill for both the spirometry and the stress test by adding modifier -59 (distinct procedural service) to the 94620, according to Walter J. ODonohue, MD, FCCP, FACP, a representative to the AMA CPT Advisory Committee for the American College of Chest Physicians (ACCP) and CPT/RUC Committee chair of the ACCP.

Coding for Oxygen Treatments

In the April 1998 Postgraduate Medicine (Vol. 103, No. 4), John G. Weg, MD, and Carl F. Haas, MLS, RRT, of the department of internal medicine at the University of Michigan Medical School in Ann Arbor, write, The role of long-term oxygen therapy for hypoxemia in patients with chronic obstructive pulmonary disease is well established. Oxygen [...]