Pulmonology Coding Alert

Experts offer quick tips for reporting all services

If your pulmonologist treats patients with sarcoidosis (135), you know that coding all the services for this complex condition can be a real challenge. You have to know how to code the patient referral and assign correct ICD-9 codes for treatment services. To make the process easier, follow these three strategies offered by coding experts. 1. Report 99245 for the Initial Consult Pulmonologists normally see a patient with sarcoidosis - a multisystem disorder with an unknown etiology that produces an inflammatory response causing granulomas in the lungs and other organs - following a referral from the patient's primary-care physician (PCP).

For instance, a patient's PCP suspects sarcoidosis when the patient complains of fatigue (780.79), cough (786.2) and shortness of breath (786.05). The PCP orders chest x-rays and requests your pulmonologist's opinion.

Your physician reviews the patient's major organ systems and finds that the patient has fatigue (780.7x), abdominal pain (789.0x) and diarrhea (787.91).

Also, your pulmonologist reviews the blood chemistry studies and the chest x-rays (71010, Radiologic examination, chest; single view, frontal) and finds mediastinal lymphadenopathy (785.6) or abnormal x-ray findings of the lung (793.1). The patient's comprehensive history reveals past liver disease (571.x), exposure to asbestos (V15.84), and occasional pleuritic pain (786.52).

Because your physician performed a comprehensive history and exam and engaged in high-complexity decision-making, you may use 99245 (Office consultation for a new or established patient ...), coding experts say. To support payment for the highest level of consultation, your pulmonologist's documentation should include notes of all work he or she performed, such as reviewing x-rays and taking a comprehensive history, and a report detailing his or her findings for the primary-care physician. Also, append modifier -26 (Professional component) to 71010 for your physician's interpretation of the x-ray films. 2. Assign ICD-9 Codes for Biopsy and Spirometry Based on the findings, your pulmonologist may perform a lung biopsy to properly diagnosis the sarcoidosis, says Charlie Strange, MD, FCCP, director of the medical intensive care unit at the Medical University of South Carolina in Charleston.

For example, your pulmonologist uses bronchoscopy (31622, Bronchoscopy [rigid or flexible]; diagnostic, with or without cell washing [separate procedure]) to inspect the lungs and to decide which airway to use to perform the biopsy. After inspection, your physician does a transbronchial lung biopsy (31628, ... with transbronchial lung biopsy, with or without fluoroscopic guidance) that same day. You cannot report both 31622 and 31628, because surgical procedure payment always includes diagnostic work. In this situation, you should report only 31628.

Also, prior to your physician's sarcoidosis diagnosis, you should link 786.05, 785.6, 780.79 and 793.1 to the biopsy (31628) to support medical necessity. Once your pulmonologist diagnoses the [...]