Pulmonology Coding Alert

Connecticut Subscriber

Answer: A spirometry is not separately billable by the pulmonologist who sees a patient in the ED. You cannot report 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) for this encounter. You could report 94010-26, if the pulmonologist interpreted the spirometry for the hospital pulmonary function lab.

In the future, see if you can roll the spirometry work into the overall E/M level. There is a chance you could increase the overall service level.

Benefit: If the pulmonologist performed enough work to increase the overall service level in your example, you could have reported 99284 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a detailed history; a detailed examination; and medical decision making of moderate complexity ...) for the service instead of 99283 (...an expanded problem-focused history; an expanded problemfocused examination; and medical decision making of moderate complexity ...). But you may only consider the spirometry for your medical decision making complexity when you are not billing separately for the service.

ICD-9 coding: When a patient has COPD along with bronchitis, be sure to choose a single diagnosis code to represent both conditions: 491.22 (Obstructive chronic bronchitis; with acute bronchitis).

Note: You don't have to report 466.0 (Acute bronchitis) for the obstructive chronic bronchitis because the code descriptor for 491.22 specifies acute bronchitis.