Pulmonology Coding Alert

Question: A new patient reports to the pulmonolgist complaining of shortness of breath and coughing. The pulmonologist performs a moderately complex E/M service, then orders a spirometry (the private practice owns the spirometry equipment) and plethysmography. Based on test results, the physician diagnoses chronic obstructive pulmonary disease (COPD) with acute bronchitis. How should I code the visit? When choosing ICD-9 codes, should I code the COPD and bronchitis separately?

Missouri Subscriber

Answer: No, you don’t have to report 466.0 (Acute bronchitis) separately for the obstructive chronic bronchitis because the code descriptor for COPD 491.22 (Obstructive chronic bronchitis; with acute bronchitis) includes acute bronchitis.

On the claim, report the following:

• 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity) for the E/M

• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99204 to show that the spirometry and E/M were separate services

• 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) for the spirometry

• 94726 (Plethysmography for determination of lung volumes and, when performed, airway resistance) for the plethysmography. You can safely code for this procedure with spiromentry as they are not bundled.

• 786.05 appended to 94010 to represent the reason for the testing, shortness of breath [For ICD-10, you will report  R06.02 (shortness of breath)

• 491.22 appended to 99204 to represent the COPD. For ICD-10, you will report J44.0 (Chronic obstructive pulmonary disease with acute lower respiratory infection).