Pulmonology Coding Alert

There are two key points to proper reimbursement when coding treatment for respiratory acidosis (276.2) and respiratory alkalosis (276.3): assigning the proper diagnosis codes and reporting all services provided. Coders often confuse acidosis and alkalosis, which can impact reimbursement significantly. Reporting the wrong ICD-9 code can mean not showing medical necessity, causing carriers to refuse payment. And in the case of acidosis and alkalosis and the extensive treatments that may be required, a sizable reimbursement could be reduced significantly. What Is Acidosis and Alkalosis? Respiratory acidosis occurs when excess carbon dioxide collects in the blood, decreasing its pH level. The excess carbon dioxide can be caused by upper or lower airway obstruction, acute infections or inflammation of the lung and bronchial tissues, or acute or chronic lung conditions, all of which prohibit the lungs from expelling carbon dioxide from the body. Hypercapnia (increased carbon dioxide in arterial blood) can also occur in association with sleep disorders. There are two types of respiratory acidosis: acute and chronic. Acute acidosis involves a relatively sudden malfunction of the respiratory system. Chronic acidosis is caused by a gradual and irreversible loss of ventilatory function, as with chronic obstructive pulmonary disease (COPD, 496).

Respiratory alkalosis results when too little carbon dioxide in the blood raises its pH level. Although rare, alkalosis may be associated with anxiety, hysteria, pain, hypoxia, fever, high environmental temperatures, early pulmonary edema, and overven-tilation with a mechanical ventilator. Interpreting Test Results Is Part of E/M The principal diagnostic test for respiratory acidosis and alkalosis is an arterial blood gas (ABG) study (82800-82810). A blood sample is taken from the artery to evaluate the ability of the lungs to move oxygen in and carbon dioxide out of the body. The sample is taken from the artery so the oxygen and carbon dioxide levels can be measured before they change when the blood enters body tissues. Often, the physician requires several ABGs to monitor the progress of the patient's condition. Pulmonologists most often encounter potential acidosis/alkalosis patients in the emergency department (ED) or in inpatient units. The facility bills for an arterial puncture (36600*, Arterial puncture, withdrawal of blood for diagnosis) and ABG (82800-82810) if its equipment, supplies and staff are used to perform the procedures and analyze the specimen. Nonetheless, the pulmonologist may incorporate the amount and complexity of data reviewed, including the ABG test results, in medical decision-making when determining the E/M service code (99281-99285, Emergency department visit for the evaluation and management of a patient ; or 99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ). Consult,Critical Care Are Options There are four potential keys to treating respiratory acidosis: maintaining a clear airway, ensuring [...]