Pulmonology Coding Alert

Pulmonologists frequently see patients suffering from chronic lung conditions that can potentially affect other organs or systems. For example, emphysema and COPD can affect the heart, and certain medications used to treat asthma may damage the liver. Consequently, routine office visits for such patients involve more than just a monitoring of the chronic pulmonary condition. The physician must also check the heart or liver as a precautionary measure. These additional examinations complicate the coding of office visits because they are needed for the well-being of the patient even though no symptoms point to a specific problem necessitating the screening procedure. To ensure prompt and complete reimbursement from both Medicare and private carriers for these procedures, coders should use the appropriate V code. Preventive or Not? As Carol Pohlig, RN, CPC, a reimbursement analyst for the office of clinical documentation in the department of medicine at the University of Pennsylvania, points out, "To the clinical world these procedures may appear to be preventive, but to the coding world they are not. The confusion is furthered when the physician refers to one of these procedures as a screening. Often, the coder does not realize what has been done and why."  She goes on to explain that the difference between the two perceptions lies in the intent behind the test, examination or procedure. The reason, for example, for giving an emphysema patient an EKG during a routine physical is different from administering the same test to a patient not suffering from the disease. For both there may be no clinical symptoms suggesting a heart problem. But unlike using an EKG as part of a physical for an insurance policy or as part of a pre-employment physical, for instance, the procedure is medically indicated for the emphysema patient because of the pulmonary disease.  Therefore, in the second situation, the EKG is not seen as preventive; rather, it is necessitated because the patient is at-risk for heart complications, and an EKG will reveal problems before physical symptoms manifest resulting in quicker and more effective treatment. Mary Jean Sage, CMA-AC, principal consultant with Sage Associates in Arroyo Grande, Calif., explains, "An EKG in this situation becomes an 'at-risk' screen, not a preventive one." It is, therefore, coded using V codes. According to the ICD-9 2001 manual, V codes are provided to deal with occasions when circumstances other than a disease or injury classifiable to categories 001-999 are recorded as diagnoses or problems. This can arise in three ways: 1. When a person who is not currently sick encounters the health services for some specific purpose, such as to act as a donor of an organ or tissue, to receive proper prophylactic vaccination, or to discuss a [...]