Pulmonology Coding Alert

Consider: Where do BMI codes fare in pulmonology? Efficient billing is not just about getting your CPTs right. You need to possess a thorough knowledge and use of modifiers and diagnosis codes before you can come full circle on efficient billing and reimbursement. While recent additions on influenza ICD-9 codes appear to be baffling ;" they took effect in the last quarter of 2010 ;" it's not what it appears to be. Catch up on these latest flu codes, along with some other pulmonology-related diagnosis codes with these useful tips. Choose From 6 Extra Flu Codes Since the debut of six new codes on influenza in October 2010, you should have been using the more specific codes in the 488.0x (Influenza due to identified avian influenza virus) and 488.1x (Influenza due to identified novel H1N1 influenza virus) subcategories. If you used to content yourself with the old code category 487 (Influenza) which didn't provide the detail you wanted for more types of the flu, now you should be using six new codes expanding from the 488.0 and 488.1 subcategories: 488.01 --" Influenza due to identified avian influenza virus with pneumonia 488.02 --" Influenza due to identified avian influenza virus with other respiratory manifestations 488.09 --" Influenza due to identified avian influenza virus with other manifestations 488.11 --" Influenza due to identified novel H1N1 influenza virus with pneumonia 488.12 --" Influenza due to identified novel H1N1 influenza virus with other respiratory manifestations 488.19 --" Influenza due to identified novel H1N1 influenza virus with other manifestations. Don't forget: As with 487.0 (Influenza with pneumonia), when you code 488.01 or 488.11, you should be using an additional code to identify the type of pneumonia (480.0-480.9, 481, 482.0-482.9, 483.0-483.8, 485) Caveat: Do not use one of these new codes unless the cause of the pneumonia is confirmed, warns Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania Department of Medicine in Philadelphia. Influenza symptoms may depend on which virus caused the infection but often are similar to those associated with seasonal influenza. "Laboratory tests can be used to confirm influenza infection. Prescription antiviral drugs approved for influenza (based on seasonal outbreak data) may be of some benefit in treating avian or H1N1 flu infection. However, influenza viruses can become resistant to these drugs, so these medications may not always work. For some of these drugs to be most effective, they must be taken within 48 hours after the first sign of symptoms. Unless there is risk for severe illness, most people are not tested nor provided with antiviral medications," she explains. BMI Codes Define More Details Forget about V85.4 (Body Mass Index 40 and over, adult). You should be using one of the following new V codes in its place: V85.41 --" Body Mass Index 40.0-44.9, adult V85.42 --" Body Mass Index 45.0-49.9, adult V85.43 --" Body Mass Index 50.0-59.9, adult V85.44 -- Body Mass Index 60.0-69.9, adult V85.45 --" Body Mass Index 70 and over, adult. Obesity can exacerbate sleep apnea, so pulmonology practices should be benefiting from the new codes that depict a higher BMI for patients. Example: A 41-year-old morbidly obese female (BMI 57.5) with obstructive sleep apnea comes to your practice because he can't sleep at night. The pulmonologist diagnoses him with sleep apnea with insomnia. You would report 780.51 (Insomnia with sleep apnea, unspecified) for the sleep apnea with insomnia as diagnosis. Additionally, you would code V85.43 because the patient's BMI is within the range of this code's as stated in its descriptor. Look for Jaw Pain Codes How are you currently addressing to report a patient's jaw pain? You should be coding 784.92 (Jaw pain) to describe this symptom. The notes made by the ICD-9-CM Coordination and Maintenance Committee in Sept. 17, 2009 stated, "it was suggested to somehow differentiate temporomandibular joint (TMJ) disorders and this code, perhaps using an excludes note." Jaw pain may be a symptom of a pulmonary embolism (415.19), or other conditions not associated with TMJ. ICD-9 code 784.92 was created to classify the patient, and justify the necessary testing/evaluation for patients who presents with this complaint.