Pulmonology Coding Alert

Question: An internist treats an established patient with controlled type II diabetes with ketoacidosis as a hospital inpatient. On day one, the internist checks on the patient during his rounds, and the patient complains of shortness of breath (SOB). Suspecting pneumonia, the internist requests a consult from a pulmonologist. On day two, tests confirm that the patient has viral pneumonia.

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Answer: The pulmonologist should report 99232 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: an expanded problem focused interval history; an expanded problem focused examination; medical decision making of moderate complexity ...) with 480.9 (Viral pneumonia, unspecified) appended as a primary diagnosis and 250.10 (Diabetes with ketoacidosis; type II or unspecified type, not stated as uncontrolled) as a secondary diagnosis.

The internist should report the appropriate hospital care code with 250.10 as primary and 480.9 as secondary.

Properly ordering the ICD-9 codes paints a complete picture of each specialist's involvement in the management of the patient's condition and ensures that both practices get paid.

The answers to the Reader Questions and You Be the Coder were provided and reviewed by Alan L. Plummer, MD, professor of medicine in the division of pulmonary, allergy, and critical care at Emory University School of Medicine in Atlanta; and Carol Pohlig, BSN, RN, CPC, ASC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.