Cold and Flu Season:
Dont Sweat It What To Do When a Cold Becomes Pneumonia
Published on Tue Jan 01, 2002
Pulmonologists often care for patients with chronic respiratory disease who develop pneumonia during the "cold and flu" season. In some situations, they must know how to code outpatient and inpatient evaluations and procedures provided on the same day to patients who become acutely ill with pneumonia-related complications.
Physicians may also be asked to provide a preoperative consultation to determine whether a patient who's had a recent bout of pneumonia and other respiratory risk factors can withstand surgery. To code these consults correctly requires an understanding of new CMS guidance for carriers, which went into effect Oct. 1, 2001, (transmittal 1719).
The following case example takes a pneumonia patient who develops empyema and atelectasis from the primary care setting through an outpatient pulmonology consultation, an inpatient stay, and a preoperative pulmonology consultation for an unrelated surgical problem.
Outpatient Treatment of Pneumonia
A 66-year-old male patient with a history of heavy smoking and chronic obstructive pulmonary disease (COPD) (496) presents to his primary care physician (PCP) with a slight fever (780.6) and productive cough (786.2). The PCP obtains a sputum for culture and sensitivity and performs a chest x-ray. The diagnosis is right lower lobe pneumonia (481). The PCP prescribes a 14-day course of quinolones and instructs the patient to return if his fever or other symptoms worsen.
The sputum culture reveals a nonspecified Gram-negative bacterial pneumonia (482.83). After five days, the patient returns to the PCP with a fever of 102 degrees,
a deep, productive cough with green, blood-flecked sputum (786.3, hemoptysis), shortness of breath (786.05) and right pleuritic chest pain (786.52). The patient is scheduled for evaluation midmorning by a pulmonologist in the same office complex.
Pulmonology Workup
The patient presents to the pulmonologist's office at 11 a.m. The physician conducts a history and physical exam and obtains a chest x-ray. He then performs a thoracentesis (32000) in the procedure room in his office, concluding that the patient may have parapneumonic empyema (510.9). By late afternoon, the lab calls back results confirming this diagnosis.
The pulmonologist consults with the PCP, who agrees the patient should be hospitalized immediately. The patient is admitted to the general medicine floor and started on IV antibiotics. That evening, the patient develops worsening shortness of breath, and an x-ray reveals a partially collapsed right lung (atelectasis). The pulmonologist inserts a chest tube (32020) in the patient's right pleural space to drain fluid, which eases breathing.
Coding Consults Versus Admissions
How the pulmonologist bills for all the prior services depends on who admits the patient to the hospital.
If the PCP admits the patient and the pulmonologist only performs the chest-tube insertion, the pulmonologist bills for the outpatient consultation earlier in the day (99241-99245), the thoracentesis (32000) and the chest-tube insertion (32020).
However, [...]
