Pulmonology Coding Alert

What is diagnosis code should I assign?

Washington Subscriber

Answer: Your best code option for this diagnosis is J45.998 (Other asthma). Several code options exist in the J45.9- (Other and unspecified asthma) code subcategory, but you can eliminate the J45.90- (Unspecified asthma) codes since the physician diagnosed the patient with a specific asthma type.

When you examine the J45.99- (Other asthma) subcategory, you’ll find the following code options:

• J45.990 (Exercise induced bronchospasm)
• J45.991 (Cough variant asthma)
• J45.998

Code J45.990 appears to be an acceptable option for the scenario you presented after a quick glance of the descriptor, but the code is incorrect. Why? The pulmonologist specifically diagnosed the patient with cold-induced asthma rather than exercise-induced asthma. The patient did complain that the symptoms started after exercising outdoors, but your code selection needs to be based on the provider’s definitive diagnosis.

You’ll then assign 94070 (Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (eg, antigen[s], cold air, methacholine)) to report the bronchospasm provocation tests. A parenthetical note under 94070 instructs you to report any administered antigens separately with 99070 (Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)) or an appropriate supply code, although most payers will not separately reimburse this code. Code 95070 (Inhalation bronchial challenge testing (not including necessary pulmonary function tests), with histamine, methacholine, or similar compounds) is used to report pharmacologic administration during testing (eg, methacholine, histamine, etc).

You indicated the pulmonologist administered methacholine, cold air, and histamines while performing 94070. You’ll assign J7674 (Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg) to report the methacholine administration, if used, and you’ll assign 99070 to report the cold air and histamine, if permitted.