Pulmonology Coding Alert

Coding for the pulmonary monitoring of cystic fibrosis (CF) patients involves reporting both E/M services and testing, which involves working your way through bundling issues and distinguishing between those services provided in the office and those performed outside. Pulmonologists, frequently called on to monitor the pulmonary manifestations of CF, perform services such as spirometry, chest x-rays and sputum testing to determine the CF patients condition throughout the course of the disease. In addition, they provide counseling and coordination of care to address any pulmonary problems caused by the condition. CF is an inherited disease that causes the mucus lining the surfaces of internal organs to become thick, dry and sticky. This denser mucus in the lungs gives bacteria a uniquely favorable place to grow. Also, CF patients are susceptible to more strains of bacteria than other people and have difficulty fighting these infections. Treating CF The pulmonologists goal when treating CF is to slow lung damage, improve breathing by loosening and thinning mucus, and prevent or reduce lung infections. "To this end, the physician employs five main treatment methods to help maintain CF patients lung health," says Vickie ONeil, CCS-P, a reimbursement specialist with Illinois Heart & Lung Associates in Bloomington, Ill. 1. antibiotics to help control and prevent lung infections
2. bronchodilators to help open airway diameters in the bronchial tree
3. mucolytics to help thin mucus
4. airway clearance techniques, such as chest physical therapy (94667, Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation; 94668, subsequent), exercise and the Flutter device, to remove mucus from the lungs
5. bronchial alveolar lavage (31624, Bronchoscopy [rigid or flexible]; with bronchial alveolar lavage) to help clear away excess mucus. A potential sixth treatment option for progressed pulmonary disease in CF patients is a lung transplant. (For more on coding the pulmonologists role in lung transplants, see the July and August 2002 issues of Pulmonology Coding Alert.) How to Report Monitoring With Spirometry Pulmonary physicians often use spirometry (94010-94070) to monitor the lung function of their CF patients. You should use 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) to indicate repeat spirometries performed to evaluate a patients response to newly established treatments, to monitor the course of CF or to evaluate a patient continuing with symptoms after initiating treatment. If the pulmonologist performs the spirometry both before and after administering bronchodilators, you should report 94060 (Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]), which includes all of the work of 94010 but gives a better analysis of the problem and the effects of treatment. There [...]