Pulmonology Coding Alert

Test your overall pulmonology coding know-how

Amidst changing codes, bundling edits, and carrier regulations, you're expected to keep up-to-date and ensure that your pulmonologist properly reports his  services. Use this quiz to see how you fare coding nebulizer, pulmonary function test (PFT), and bronchoscopy scenarios you may see in your pulmonology practice. 

Question 1: Your nurse administers nebulizer training to an established patient who has acute bronchitis. Because the primary reason for the visit was the training, the nurse doesn't provide any other services, E/M or procedural. How should you report this patient's office visit?

Question 2: Your pulmonologist orders a respiratory flow volume test. The patient undergoes the test in an outpatient hospital setting, and the pulmonologist interprets the results. What code should you report for the test?

Question 3: A patient presents to your practice with cough, sputum and fever. An x-ray shows a right-lower lobe infiltrate, so your pulmonologist performs a bronchoscopy. The documentation states that during the bronchoscopy the physician "instilled 100 ml of saline into the patient's right-lower lobe, and the operator received a return of 35 ml of fluid."

Based on this information, how should you report the physician's work?

Answer 1: When your nurse provides nebulizer training and no other services, you should report only 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered- dose inhaler or IPPB device).

Reporting this code requires the physician presence in the office at the time of service. If the physician is not able to provide this level of direct supervision, you may not report this code.

The code for a nurse visit, 99211 (Office or other outpatient visit for the E/M of an established patient ), isn't appropriate because the patient presented to the office for training on how to use the nebulizer and did not receive any further evaluation or treatment.

Use 466.0 (Acute bronchitis) as the related diagnosis code.

Answer 2: You should report 94375-26 (Respiratory flow volume loop; professional component), and the facility should report 94375-TC (Respiratory flow volume loop; technical component). 

You need to consider where a pulmonary function test (PFT) took place to correctly report the test. PFTs have both a professional and a technical component. Therefore, the location of the testing plays a part in how you code these tests.
 
Note: If a technologist performs a PFT and the physician provides the supervision and interpretation of the test in a private setting, such as the physician's office, you can report both the professional and the technical components together by using the correct CPT code without modifiers (e.g., 94375).

Answer 3: The description of the procedure indicates that your pulmonologist completed a bronchoalveolar lavage (BAL), so you should report 31624 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with bronchial alveolar lavage). Don't confuse this code with 31622 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]) for a basic bronchial wash.
 
Use the following diagnosis codes to represent the patient's symptoms: 786.2 (Cough), 786.4 (Abnormal sputum) and 780.6 (Fever).

Answers for this quiz were reviewed by Lisa Center, CPC; and Greg Brunow, CPC, coders for the Mt. Carmel Regional Medical Center in Pittsburg, Kan.