Pulmonology Coding Alert
Focus on Single Diagnosis During E/M Encounter
Question: My pulmonologist sees an established patient who complains of trouble in breathing, and frequent coughing. She tells the physician that it hurts when she breathes. During a level-three E/M service, the pulmonologist diagnoses obstructive chronic bronchitis without exacerbation, prescribes antibiotics, and sends the patient home. Should I bill all the presenting symptoms besides the bronchitis? Florida Subscriber Answer: Only one diagnosis codes links to the E/M. In short, you don't need to code for the patient's presenting symptoms since the pulmonologist reached a diagnosis during the encounter. This is what you'd report on the claim: 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity ...) for the E/M. 491.20 (Obstructive chronic bronchitis; without exacerbation) appended to 99213 to represent the patient's bronchitis. Otherwise, if the pulmonologist had not reached a final diagnosis during the encounter, then you would have appended codes for the patient's presenting symptoms (786.2, Cough; 786.52, Painful respiration) to 99213.
Pulmonology Coding Alert
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