Pulmonology Coding Alert

Find out why coding for primary source of tumor is as important as coding for the tumor itself.

Malignant lungs/bronchial tumor and pleural effusion are two of the most common diagnosis in pulmonology. If your mind is set a year back in time for these conditions, you could easily mix up the old and new ways of coding them. For instance, you now need to be on the lookout for the source of a primary tumor when coding pleural effusions.

Check out if you've got the answers for the quiz right.

209.21, 209.61 End Scrambling for Dx Code on Different Tumor Types

Scenario 1: The pulmonologist performs bronchial biopsies on a mass in a patient's upper bronchus. Pathology reports come back indicating a malignant carcinoid tumor. What should you report?

Solution 1: You should report 31625 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with bronchial or endobronchial biopsy[s], single or multiple sites) for the bronchoscopy, and 209.21 (Malignant carcinoid tumor of the bronchus and lung) linked to 31625 to represent the tumor. Make sure you wait for the result of the biopsy before you choose between 209.21 and 209.61 (Benign carcinoid tumor of the bronchus and lung).

You'll often use 209.21 or 209.61 on your lung biopsy claims. These could be repeat biopsies in which you already have a diagnosis, or initial biopsies in which the physician is unsure of the patient's status.

In the past: Coders may have mistakenly reported 162.9 (Malignant neoplasm of trachea, bronchus and lung; bronchus and lung, unspecified) for all malignant lung/bronchial tumors, and 212.3 (Benign neoplasm of respiratory and intrathoracic organs; bronchus and lung), regardless of the type or specified area.

511.81: Don't Forget Fifth Digit in Malignant Pleural Effusion Coding

Scenario 2: X-ray results brought to the pulmonologist's office indicate that the patient has a probable malignant pleural effusion. The pulmonologist performs a thoracentesis with tube on a patient with malignant cancer of the main bronchus. What codes would you bill in this case?

Solution 2: You should bill the following codes on your claim: 32422 (Thoracentesis with insertion of tube, includes water seal [e.g., for pneumothorax], when performed [separate procedure]) for the thoracentesis, 511.81 (Malignant pleural effusion) to represent the malignant effusion, and an additional code to represent the underlying condition such as162.2 (Malignant neoplasm of trachea, bronchus and lung; main bronchus).

Caution: Wait for the final diagnosis from cytology on the pleural fluid before coding 511.81. You should also report the source of the primary tumor.

A malignant pleural effusion is caused by a cancerous invasion of the pleura. This could be due to cancer within the lung or metastatic disease from any other organ (such as the colon or kidney), says Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta.

When the patient has a pleural effusion that does not include cancer or tuberculosis, you would bill 511.89 (Other specified forms of effusion, except tuberculosis) on your claim.

In the past: For a malignant pleural effusion, coders may have reported 197.2 (Secondary malignant neoplasm of respiratory and digestive systems; pleura).