Pulmonology Coding Alert

Occupational history is the main clue to diagnosis.

As a pulmonology coder, you're likely to encounter patients with extrinsic allergic alveolitis (hypersensitivity pneumonitis). To be ready to accurately report for every type of extrinsic allergic alveolitis (EAA) when ICD-10 codes come into effect, see our guidance that follows.

Take This Symptoms, Tests Refresher

Your pulmonologist will arrive at a diagnosis of bagassosis based on an occupational history of exposure to cane dust and on the findings of blood tests and diagnostic tests such as pulmonary function tests and chest x-rays.

Some of the common symptoms that you will encounter in a patient with bagassosis will include fever (R50.9, Fever unspecified), malaise (R53.81, Other malaise), fatigue (R53.83, Other fatigue), cough (R05, cough), shortness of breath (R06.02, Shortness of breath), painful breathing (R07.1, Chest pain on breathing), anorexia (R63.0, Anorexia) and weight loss (R63.4, Abnormal weight loss).

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).

Chest x-rays and 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) may help confirm the diagnosis.

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) to confirm the diagnosis.

495.1 Becomes J67.1

Under ICD-9, you would use 495.1 (Bagassosis). The fourth digit is specific for the type of EAA, and 495.x expands to 10 different codes depending on the type of inhaled organic dust particles the person is exposed to.

Under ICD-10, you will report J67.1 (Bagassosis). Observe that the descriptor for bagassosis remains the same as the descriptor that is used in the ICD-9 code for the condition.

Example: A male patient arrives at your pulmonologist's practice 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. The occupational history of the person working in a cane extraction unit makes your pulmonologist suspicious of EAA.

Upon further blood tests and PFT, your pulmonologist is able to confirm the diagnosis of Bagassosis. You will have to report the condition with J67.1, along with Z57.2 (Occupational exposure to dust). You report the evaluation and management of the patient with E/M codes 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem[s] and the patient's and/or family's needs. Usually, the presenting problem[s] are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family).