Pulmonology Coding Alert

Thromboembolic disease, a tendency toward blood clotting in the arterial system, is most commonly diagnosed as deep venous thrombosis (DVT) or a blood clot in the leg using 451.11 (phlebitis and thrombophlebitis; of deep vessels of lower extremities) or 451.19 ( other).
 
Pulmonary embolic disease, similar to thrombo-embolic disease but occurring in the pulmonary system rather than the arterial system, requires codes different from those used to report thromboembolic disease.
 
Coders must take great care to distinguish diagnosis codes that apply to the arterial system from those that apply to the pulmonary system. For example, a pulmonologist examining a patient who presents for a pulmonary embolism may not find emboli in the lung area. "Many times when we go looking for emboli in the lungs, we find it in the legs," says Charlie Strange, FCCP, of the department of pulmonary medicine at the medical university of South Carolina. "A doctor may be called in for chest pain, but didn't identify emboli in the lung and instead finds clots in the leg. So, even though the patient may have had a pulmonary embolism, the only evidence is DVT, which utilizes diagnosis codes 451.11 to 451.19."
 
Pulmonologists will report "pulmonary embolism" as their primary diagnosis because that is the condition they are treating, with DVT being the underlying condition.
Typical Diagnostics for DVT and PE
Many symptoms characterize thromboembolic disease, some of which can impact the pulmonary area. A patient who presents with acute shortness of breath, chest pain, dizziness and coughing up blood is diagnosed with a pulmonary embolism (PE) using 415.11-415.19. Extensive tests are required before the physician can reach a primary diagnosis of DVT or PE and begin a regimen of coagulation therapy to stabilize the patient and reduce the risk of further clotting. The physician cannot bill for the combination drug therapy, because a hospital would administer it on an inpatient basis or a nurse would administer it once the patient is released.
 
The physician can only bill for services that he or she has rendered. For example, a physician can bill for an x-ray if it was performed and interpreted in his or her office. Use a code from the series 71010 (radiologic examination, chest; single view, frontal) to 71035 (radiologic examination, chest, special views [e.g., lateral decubitus, Bucky studies]).
 
However, a physician who suspects a pulmonary embolism typically orders an x-ray, ventilation perfusion lung scan or spiral CT scan with contrast to look for lung defects, or a pulmonary arteriogram to look for emboli in pulmonary arteries, venous plethysmography (non-invasive screening vascular study to identify a blood clot), or a venogram that injects dye in the venous system if noninvasive studies are inconclusive. Pulmonologists cannot bill [...]