Pulmonology Coding Alert

These codes tell you when care justifies 2 specialists.

Before you brace for a denial because another physician submitted his respiratory care claim in advance of your pulmonologist, take a look at this list of approved concurrent care diagnoses.

Examples of respiratory conditions occurring in outpatients or inpatients which would merit concurrent care, according to a 2008 Highmark Health Insurance Company Medicare Advantage policy bulletin, include:

" Acute bronchitis (466.0) and acute bronchiolitis (466.1) " Acute diseases of pharynx, larynx, and nasal sinuses (for instance, 478.21, Cellulitis of pharynx or nasopharynx; or 461.x, Acute sinusitis)

" Bronchial asthma, acute (493.9x)

" Chronic obstructive pulmonary (or lung) disease with (acute) exacerbation (491.21)

" Congenital anomalies of the respiratory system (748.x)

" Cystic fibrosis (277.02, & with pulmonary manifestations)

" Hyaline membrane disease (769)

" Infection and abscess of lung and pleura (such as 510.9, Empyema without mention of fistula)

" Pleural effusion (for instance, 511.9, Unspecified pleural effusion)

" Pneumonia and pneumonitis (for example, 486, Pneumonia, organism unspecified; or 507.x, Pneumonitis due to solids and liquids).

Conditions that physicians most commonly treat in an inpatient setting that merit concurrent care include:

" Pneumothorax, and injury to lung and other noncardiac intrathoracic organs (for instance, 512.0, Spontaneous tension pneumothorax)

" Pulmonary edema (for instance, 506.1, Acute pulmonary edema due to fumes and vapors)

" Pulmonary embolism (such as 415.12, Septic pulmonary embolism)

" Pulmonary emphysema, (for instance, 492.8, Other emphysema)

" Pulmonary fibrosis and diseases of alveoli (for example, 515, Postinflammatory pulmonary fibrosis)

" Pulmonary hemorrhage (786.3)

" Respiratory acidosis (276.2) or alkalosis (276.3)

" Respiratory arrest (799.1)

" Respiratory insufficiency or failure (for instance, 518.81, Acute respiratory failure).