Pulmonology Coding Alert

You can read coding articles until you're blue in the face, but if you can't remember them, you're not getting your money's worth. You can code more reports if you commit a bit more coding advice to memory.

Take the following quiz to assess your coding accuracy, then scroll to the bottom to check your answers with those provided by pulmonology coding experts. 

Fill in the Blanks

Question #1: Your pulmonologist evaluates (99213, Office or other outpatient visit) and treats a patient who has acute bronchospasm with nonpressurized airway treatment (94640). Later that day, the patient returns complaining of shortness of breath (786.05) and goes into respiratory arrest (799.1). For the first visit, you would report 94640 and 99213 along with ________ (modifier -25 [Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure of other service] or modifier -59 [Distinct procedural service]). For the second visit, you would add up your physician's time and report the appropriate code for ___________ ("critical care 99291-99292" or "subsequent hospital care 99231-99233").

Question #2: When your pulmonologist provides a service, such as bronchoscopy (31622-31656), beyond the normal time or scope of what he or she normally provides, you can append _________ (modifier -22 [Unusual procedural services] or modifier -26 [Professional component]) to the procedure.

Question #3: To bill for both a pulmonary stress test (94621, Pulmonary stress testing; complex [including measurements of CO2 production, O2 uptake, and electrocardiographic recordings]) and a cardiac stress test (93018, Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only), you should attach modifier -59 to ________ (94621 or 93018). Also, you must use a different ________ (ICD-9 code or modifier) for each test, and provide separate _______ (claims or written reports) for both tests with different information and data, which draw different conclusions.

Question #4: A primary-care physician (PCP) decides that he or she can't manage a patient's emphysema (492.x) treatment and transfers the patient's care to your pulmonologist. After your physician sees the patient, you should code the visit as a/an _________ (new patient visit or office consultation), using codes __________ (99201-99205 or 99241-99245).

Question #5: At-home spirometry, which you should report as _______ (94010 or 94014) isn't intended for the average asthmatic. Your pulmonologist might use this procedure as a surveillance method to prevent acute situations in the patient with _______ (wheezing or chronic asthma), ________ (intercurrent upper respiratory infections or chronic bronchitis), or following a _______ (bronchoscopy or lung transplant). In addition, within a 90-day period, the patient must have been _________ (hospitalized twice or for an office visit) or __________ (using prescribed medication or visited the emergency room three times).

Check the following answers to the quiz questions to see how you did.
Answer #1: Modifier -25, Critical care 99291-99292
Answer #2: Modifier -22
Answer #3: 93018, ICD-9, written reports
Answer #4: New patient visit, 99201-99205
Answer #5: 94014, chronic asthma, intercurrent upper respiratory infections, lung transplant, hospitalized twice, visited the emergency room three times.