Pulmonology Coding Alert

Hint: Use same diagnosis code if your clinician diagnoses cork-handler’s disease.

When your pulmonologist diagnoses suberosis, a form of extrinsic allergic alveolitis (EAA), you’ll be pleased to know that there is a straight-forward transition from ICD-9 to ICD-10 set of codes with similar set of inclusions and exclusions for the two codes.

ICD-9: When your pulmonologist diagnoses suberosis, you’ll have to report it with 495.3 (Suberosis) when you are using ICD-9 codes. You’ll use the same diagnosis code if your clinician mentions the diagnosis as cork-handler’s disease of the lung. You can use 495.3 if the diagnosis is also allergic alveolitis and pneumonitis due to inhaled organic dust particles of fungal, thermophilic actinomycete, or other origin.

ICD-10: When you begin using ICD-10 codes, a diagnosis of suberosis that you report with 495.3 in ICD-9 crosswalks to J67.3 (Suberosis) in ICD-10. As you can note, there are no descriptor changes to the code in ICD-10. As in ICD-9, you’ll use J67.3 if your practitioner’s diagnosis is corkhandler’s disease of the lung or even corkworker’s disease of the lung.

Review these Basics Briefly

Documentation Spotlight: Your pulmonologist will arrive at a diagnosis of Suberosis based on a thorough history, medical examination, signs and symptoms and based on the findings of blood tests and diagnostic tests such as pulmonary function tests and chest x-rays.

An occupational history of exposure to moldy cork dust along with other presenting symptoms will make your pulmonologist suspicious of a diagnosis of suberosis. Some of the common symptoms that you will encounter in a patient with suberosis will include fever, malaise, fatigue, cough, shortness of breath, painful breathing, anorexia and weight loss.

Tests: To arrive at a definitive diagnosis of suberosis, your pulmonologist will have to undertake further tests and perform other diagnostic procedures to confirm the condition. Your pulmonologist might order certain lab tests such as blood count (85025, Blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count] and automated differential WBC count) and certain immune assays (86001, Allergen specific IgG quantitative or semiquantitative, each allergen).

Your pulmonologist will also use the aid of chest x-rays and performs certain diagnostic tests such as bronchoscopy (31622, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]) or bronchoscopy with biopsy (31628, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy[s], single lobe).

Your pulmonologist will also rely on pulmonary function tests such as spirometry (94010, Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation), determination of lung volumes (94727, Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes), diffusing capacity (+94729, Diffusing capacity [e.g., carbon monoxide, membrane] [List separately in addition to code for primary procedure]) and respiratory flow volume (94375, Respiratory flow volume loop).

Example: A 53-year-old male patient arrives at your pulmonologist’s office with symptoms of cough, dyspnea, fever with chills, malaise and headache. Your pulmonologist performs a thorough evaluation with a thorough recording of the patient’s history. During history recording, the patient reveals that he used to work as a cork handler for almost 15 years. This occupational history makes your pulmonologist suspicious of EAA.

To confirm the diagnosis, your pulmonologist orders some blood tests and PFT such as spirometry, diffusing capacity, respiratory flow volume and determination of lung volumes. He also performs a bronchoscopy and orders for a chest x-ray.

Based on history, observations made at physical examination and results and interpretations of tests and imaging studies along with the observations made during bronchoscopy, your pulmonologist is able to confirm the diagnosis of suberosis.

What to report: You report the evaluation and management of the patient with E/M codes 99203 (Office or other outpatient visit for the evaluation and management of a new patient…). You report the bronchoscopy with 31622 and report the PFT studies with 94010, 94727 and +94729. You do not report 94375 separately as this is bundled with 94010 as per Correct Coding Initiative (CCI) edits with the modifier ‘0.’ You report the diagnosis with J67.3 if you are reporting using the ICD-10 code sets or use 495.3 if you are using the ICD-9 set of codes.