Pulmonology Coding Alert

Question: Recently our pulmonologist saw a patient in the morning for upper respiratory infection. Later that same week, the patient returned with epigastric pain. Can we code these two separate encounters and receive reimbursement for them?

Kansas Subscriber Answer: Yes. Your pulmonologist should prove medical necessity for each service and report diagnosis codes to support the signs and symptoms of an upper respiratory infection (465.9).

For instance, the patient may have a cough (786.2), sore throat (462) and fever of nonspecific origin (780.6), which led your physician to diagnosis an upper respiratory infection. Therefore, your pulmonologist subscribed medication.

The patient's complaint of epigastric pain (789.06) probably represents an adverse reaction to the prescribed medication. This is a good example of when to use E codes, which describe circumstances that caused the injury, not the nature of the injury. If your physician determines that the symptom(s) are related to therapeutic antibiotic use, he or she should use E930.3, for example, if the patient took erythromycin in addition to the epigastric pain. You cannot use E codes independently, because they only represent the problem's cause.