Pulmonology Coding Alert

Question: An 86-year-old male with a background of pulmonary fibrosis and asthma was admitted to hospital with a sixmonth history of a productive cough, fever and increasing dyspnea. He produced approximately one teaspoon of white sputum per day but noticed that the cough was exacerbated significantly after eating dry food. His x-ray on admission showed evidence of pulmonary fibrosis and aspiration pneumonia, but did not obviously highlight a cause for his current medical admission. At meal times he experienced slight dysphagia and coughed up some of the ingested food including his medications. A gastroeneterologist was consulted who investigated him further by performing a barium swallow which revealed a pharyngeal pouch (Zenker's diverticulum). Incidentally, a chest x-ray performed after the barium swallow highlighted the pharyngeal pouch containing the ingested barium that was not as obvious on his admission chest x-ray. What CPT® and ICD-9 codes should the pulmonologist report to Medicare for this scenario?

Illinois Subscriber

Answer: Since the pulmonologist was the admitting physician, he can report the appropriate initial hospital care code (99221-99223), being sure to append modifier AI (Principal physician of record) to the code to identify the pulmonologist as the attending of record. The pulmonoligist would only report the ICD-9 code(s) for the conditions corresponding to his assessment and management: 507.0 (Pneumonitis due to inhalation of food or vomitus), 515 (Postinflammatory pulmonary fibrosis), and 493.90 (Asthma unspecified).The gastroenterologist would also report the appropriate initial hospital care code (99221-99223) since Medicare no longer recognizes consultation codes. No modifier is required for this service. The gastroenterologist would report 530.6 (Diverticulum of esophagus acquired) as his ICD-9 code.

Definition: Use modifier AI for the admitting or attending physician who oversees the patient's care, separate from other physicians who may be furnishing specialty care.