Pulmonology Coding Alert

Report anemia and fever to justify procedures  

When pulmonologists diagnose acute chest syndrome (ACS, 517.3), you'll need to know how to code such procedures as sputum analyses and bone scans, along with signs and symptoms.
 
Typically, ACS strikes patients with sickle-cell disease (282.6x). The patients present to your pulmonologist after a hematologist refers them, says Mary Mulholland, BSN, RN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania's department of medicine in Philadelphia. Before your pulmonologist makes an official acute chest syndrome diagnosis, report signs and symptoms common among ACS patients to justify your physician's services.
 
For example, a sickle-cell patient's hematologist sends the patient to your pulmonologist after complaints of shortness of breath (786.05), rib wall tenderness (786.59), chest pain (786.5x), difficulty breathing (786.09), and fever (780.6). Your physician obtains a comprehensive history; performs a comprehensive exam, which includes reviewing all organ systems; and orders and interprets x-rays, which indicate new infiltrates on the lung (518.3, Pulmonary infiltrates).
 
In addition, you will probably have to report your physician's review of sputum analyses (89350, Sputum, obtaining specimen, aerosol induced technique [separate procedure]) and bone scans (78300, Bone and/or joint imaging; limited area), Mulholland says. Our experts offer three tips for recouping the proper reimbursement for
ACS services: 1. Link 786.59 to Chest X-Rays Payment for x-ray interpretations depends on who reads the films. To report the physician's x-ray interpretation, attach modifier -26 (Professional component) to 71010 (Radiologic examination, chest; single view, frontal), unless your physician owns the x-ray equipment or the radiologist plans to bill for the interpretative work in addition to the technical component. Link the above signs and symptoms, such as chest pain (786.5x) and rib cage tenderness (786.59), to 71010-26, says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C.
 
Because your pulmonologist performed a comprehensive history and exam and engaged in high-complexity decision-making, you may code 99245 (Office consultation for a new or established patient ...).
 
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 examining all the body systems, as well as reporting findings to the hematologist.
 
Remember, if you want to report a consultation code, another physician must request a consultation, your pulmonologist should provide an evaluation and recommendations for treatment, and your physician must send a report detailing his or her findings to the requesting physician, Callaway says. 2. Use 958.1 for Fat Embolism Injuries When reporting to carriers, you should also rely on signs-and-symptoms coding because physicians have a difficult time distinguishing between ACS and pneumonia (480.x) during an acute episode, Mulholland says.
 
Physicians often find [...]