Pulmonology Coding Alert

Pulmonologists should code the treatment of adverse effects from medication based on whether the correct medicine was taken, whether it was taken in the recommended dosage, and whether it was combined with incompatible substances. These problems can occur due to patients misreading prescription labels, or miscommunication between specialists regarding the full list of drugs that the pulmonary patient is taking.

We occasionally see patients with adverse reactions to medications, says Diana Selby, RN, a nurse at Pulmonary Associates, a three-pulmonologist practice in Owensboro, Ky. Most of the problems are in connection with the inhalers, especially albuterol, because its prescribed very often, says Selby. The problem often involves the inert ingredients in the inhalant. For example, we have one patient who is allergic to corn products, which can be used as part of the propellant in some of the inhalers.

If a patient overuses an albuterol inhaler, he or she may experience trembling, high blood pressure, or fast or irregular heartbeats. An actual overdose may leave a patient gasping for breath. Other drugs, such as Atrovent, may cause problems when used by patients with allergies to peanuts or soy. The following factors also add to medication problems:

most patients take prescription medication from
other physicians for other problems and dont always tell
their pulmonologists about them;
patients may be taking megadoses of herbs and vitamins,
but dont report them because they dont think of them as
medication;
elderly patients may become confused when trying to
juggle their medicine regimens; and
patients may not report potential problem symptoms.

Determining the Cause of Adverse Reactions

A patient with asthma (ICD-9 493.00 -ICD-9 493.91 ) receives a prescription for theophylline. The patient fills the prescription and takes her first dose that afternoon. The next day, she phones the pulmonologist, stating that she is experiencing nausea, nervousness, an increased heart rate and a severe headache. The pulmonologist asks the patient to come back to the office. He examines her for 10 minutes and determines that the patient may be experiencing symptoms related to the theophylline.

The case seems fairly straightforward until you consider all of the diagnosis coding scenarios it represents. Reviewing the ICD-9 Table of Drugs and Chemicals causes more confusion. The table has six column heads poisoning, accident, therapeutic use, suicide attempt, assault and undetermined. There is no single, simple answer on how to code the problem. A professional coder needs to consider the specific clinical situation and carefully review the pulmonologists notes. To ensure proper reimbursement, follow these four steps:

1. Determine whether the drug was taken properly. Coders must be able to determine whether the patient took the medication correctly, according to Kathryn Cianciolo, MA, RRA, [...]