Pulmonology Coding Alert

Question: How should I code for an evaluation of hepatitis C in patients who have pulmonary fibrosis?

New York Subscriber

Answer: Pulmonologists would not typically treat hepatitis C in their pulmonary fibrosis patients. If the physician suspects hepatitis C, he or she should order blood work to test for the virus. If the blood test is positive, then the pulmonologist would send the patient to a gastroenterologist to confirm the diagnosis and manage and treat the hepatitis C as necessary.

A patient who has suspected hepatitis C can present to the pulmonologist with chronic fatigue (780.7x) or jaundice (782.4) in addition to an underlying condition of inflammatory myopathy (359.x) or pulmonary fibrosis (515). You should code the symptoms (e.g., 780.7x) to support the need for diagnostic testing until the condition is confirmed as hepatitis C. You should never code for suspected conditions, only the signs and symptoms.

Select the E/M code that appropriately represents the visit type and level of service (99211-99215 for an established patient, or 99201-99205 for a new patient). The technical component of the actual lab work cannot be billed unless the pulmonologist has an accredited lab in the office to do the test. You may be able to bill for obtaining the blood specimen if that was performed in the office. Code the blood draw G0001 (Routine venipuncture for collection of specimen[s]) for Medicare patients and 36415* (Routine venipuncture or finger/heel/ear stick for collection of specimen[s]) for non-Medicare patients.