Pulmonology Coding Alert

To ensure proper diagnosis coding for spirometry, you need to remember two things: specificity and medical necessity. Spirometry (94010, Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation; and 94060, Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]) is arguably one of the most common diagnostic tests performed by pulmonologists. The procedure measures how quickly the patient's lungs can move air in and out, as well as how much. The patient breathes into a mouthpiece of a tube connected to the spirometer, which measures the airflow. The procedure is useful to detect obstructive airway diseases, such as asthma and chronic obstructive pulmonary disease (COPD). Three Steps to Specificity Reimbursement for spirometry is now based on CPT codes, not on the diagnosis. But the payment depends on whether you establish a credible medical necessity for the procedure by applying the correct diagnosis code. These codes tell the payer why the pulmonologist performed the spirometry. And increasingly, carriers are denying payment if the ICD-9 codes are not specific enough. You can ensure you are coding to the highest possible level of specificity by following a sound coding and assessment process, which has three steps:

1. Gather complete information. When you are translating the physician's encounter information into codes, you need complete information. You may not have enough information to code the services based on the pulmonologist's written notes.

For example, if the doctor simply writes "chronic bronchitis" in the patient's record, you need more information. Chronic bronchitis (491) is an incomplete (truncated) code and will be denied because of missing digits. You need the data that will help you determine the type of chronic bronchitis and whether it is a confirmed or "rule-out" diagnosis. A rule-out diagnosis is clinically important to have in the chart, but it will not justify the procedure or service from the insurer's perspective, and it cannot be coded directly. Consequently, you will have to seek out more information on the specific symptoms from the patient's chart or by asking the physician. Specific diagnosis coding requires clear access to all the necessary information. Ideally, diagnosis information should come from the pulmonologist's clear, concise and specific diagnosis written in the patient's chart. But this kind of detail is often the exception in many practices. "You may want to use an encounter form that lists the common diagnoses along with a clear indicator when more specificity is needed," says Heidi Stout, CPC, CCS-P, coding and reimbursement manager for University Orthopaedic Associates in New Brunswick, N.J. This will help educate the pulmonologist about which ICD-9 codes require more information. For example, you can use a line after [...]