Pulmonology Coding Alert

Question: One of the pulmonologists in my practice saw a patient in consultation at the hospital. The documentation gave several diagnoses, e.g., respiratory insufficiency, pulmonary edema, etc. Now the diagnosis that the pulmonologist chose to write on the rounding sheet was "lung cancer." There was absolutely no place in the dictated consultation report stating that the patient had cancer or that the patient was having testing to determine if he had cancer. I was told, after the fact by the nurse, that the cancer diagnosis had been determined via a bronch with biopsy that the doctor performed after the consult. What diagnoses should I have used for this patient's consultation?


Florida Subscriber

Answer: You can only report ICD-9 codes after your physician establishes a diagnosis. Since the pulmonologist made the diagnosis of lung cancer after he performed the consult, you should use an ICD-9 code substantiated by the data in the physician's note on the date he provided the service.

When the documentation states that the patient had both respiratory failure and pulmonary edema, you should use 518.81 (Acute respiratory failure) if the patient had acute respiratory failure or 518.83 (Chronic respiratory failure) if the patient had chronic respiratory failure. If the patient had pulmonary edema due to left heart failure, report 428.1 (Left heart failure). For heart failure that is nonspecific, use 428.0 (Congestive heart failure, unspecified).

If the edema was secondary to the acute respiratory distress syndrome, then one code, 518.82 (Other pulmonary insufficiency, not elsewhere classified), would suffice for the respiratory failure and the edema. Don't report 162.9 (Malignant neoplasm of bronchus and lung, unspecified) since the physician made that diagnosis after performing the consultation.