Pulmonology Coding Alert

Do you know how to handle preoperative visits when the patient has comorbidities? Check your consult coding savvy with these two real-life examples:

Example 1: A general surgeon refers a 66-year-old smoker with obstructive bronchitis and emphysema to a pulmonologist for a preoperative examination prior to a colon resection for cancer. After reviewing a recent chest x-ray and pulmonary function tests, the pulmonologist performs a level-five consultation and clears the patient for surgery. The pulmonologist sends the surgeon a complete report, including the recommendation for therapy and a copy of the pulmonary function studies.

Code it: The above example is a pre-op consultation the pulmonologist conducted because of a comorbid condition. On the claim, report 99245 (Office consultation for a new or established patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity ...) for the consult and 491.20 (Obstructive chronic bronchitis; without exacerbation) to represent the patient's pulmonary diagnosis.

Example 2: A 68-year-old patient who smokes and has been diagnosed with COPD and uncontrolled type II diabetes is about to undergo a major surgical procedure. Before the operation, the surgeon requests a preoperative evaluation to assess the patient's surgical risk. The pulmonary physician performs a level-five office consult service, determines the patient is a candidate for surgery, and sends the surgeon a report detailing his pre- and postoperative recommendations.

Code it: Report this service as a preoperative consultation as well, says Mary Mulholland, MHA, RN, CPC, senior coding and education specialist for the department of medicine at University of Pennsylvania Health System in Philadelphia.

On the claim, report 99245 for the consultation service. Then add diagnosis codes V72.82 (Pre-operative respiratory examination), 496 (Chronic airway obstruction, not elsewhere classified), 250.02 (Diabetes mellitus without mention of complication; type II or unspecified type, uncontrolled), and 305.1 (Tobacco abuse disorder). Complete the claim by reporting the reason for the surgical procedure.