Pulmonology Coding Alert

Several signs and symptoms affect patients with systemic lupus erythematosus (SLE, 710.0). Although not all of these may be pulmonary-related, they may still affect coding for your pulmonologists services.

Patients with advanced lupus pleuritis often demonstrate increased fatigue and weakness (780.79), loss of appetite (783.0), nausea alone (787.02), vomiting alone (787.03) or both nausea and vomiting (787.01), signaling damage to the lungs. SLE-related pneumonitis usually manifests with fever (780.6), chest pain, shortness of breath (786.05) and cough (786.2).

Until SLE is diagnosed, you should not link 710.0 to procedure or E/M service codes. Instead, you should use signs and symptoms codes, such as severe chest pain (786.5x). Once SLE is diagnosed, you can use additional codes to report the pulmonary manifestations of the condition, as well as its severity. And, pulmonologists would not report 710.0 alone because they generally do not treat all of the diseases systemic effects, just the pulmonary ones. You should use 517.8 (Lung involvement in conditions classified elsewhere) in addition to 710.0. Code 517.8 should not be used as the primary diagnosis, however, and cannot be listed first on the claim.

Before SLE is diagnosed, and before its pulmonary involvement is confirmed by diagnostic testing, the following symptoms may manifest and should be noted on the patients chart and coded for billing: extreme fatigue (780.79), joint inflammation (716.9x), fever (780.6), weight loss (783.21) and the skin manifestations (discoid lupus, 695.4) that sometimes accompany SLE. Lupus can involve every part of the body, including the lungs, brain, joints, skin, heart and kidneys.

Clinical manifestations may also include hemolytic anemia (283.9), neutropenia (288.0), thrombocytopenia (287.5), venous thrombosis (453.9) or arterial thrombosis (444.9), pericarditis, myocarditis (429.0) and inflammation of the endocardium (424.91, which should be used only in addition to the code for SLE, 710.0). If the pulmonologist documents the site of the venous thrombosis, you should use the corresponding code from 453.0-453.8. Similarly, you should use the more detailed code for the arterial thrombosis (444.0-444.89) if you know which artery is involved.

Although these signs and symptoms may be separate from the condition the pulmonologist is treating, any of them can be pertinent to the medical decision-making process and help support the physicians E/M service level.