Pulmonology Coding Alert

If you're tired of stressing about how to code for the numerous tests your doctor uses to diagnose occupational antigen diseases, just remember that selecting the appropriate diagnosis code can solve the mystery behind reporting separate pulmonary function tests and E/M services.

Because environmental antigens find their unsuspecting human hosts in a broad range of everyday places, pulmonologists face a growing number of mysterious cases that they may misdiagnose and report as common respiratory problems, such as asthma. Dust in the air (whether inorganic, such as silica, or organic, such as tree bark, pigeon droppings and mold) infiltrates the human body and causes the immune system to make antibodies, says Anthony Marinelli, MD, FCCP, chairman of the American Thoracic Society's Clinical Practice Committee. These antibodies attach to the antigens, and the antigens go through the body attacking organs, often the lungs.

When a patient has a Type III allergic reaction to environmental allergens and develops local inflammation that causes tissue damage, the pulmonologist should diagnose the patient as having a common occupational antigen disease hypersensitivity pneumonitis. The steps that a pulmonologist must take to properly diagnose this disease, however, can lead to complicated coding issues. Sift through the Numerous Diagnosis Codes Hypersensitivity pneumonitis is an inflammatory lung disorder that is often referred to as extrinsic allergic alveolitis (EAA). The disorder is the result of long-term or intense exposure to environmental antigens, such as inorganic dust and other occupational antigens. You will encounter patients with this disease if you practice in certain areas of the country, such as cities with nearby farms or factories, says Jeffrey Berman, MD, FCCP, executive director of the Florida Pulmonary Society. Symptoms can include fever (780.6), shortness of breath (786.05), chest pain (786.50), weight loss (783.21) and fatigue (780.79), Marinelli says. Once the pulmonologist definitively diagnoses the patient with EAA, you should code to the highest level of specificity. The ICD-9 manual covers EAAin the 495.x series (Extrinsic allergic alveolitis) and differentiates among antigens by using a fourth digit: 495.0 Farmers'lung 495.1 Bagassosis 495.2 Bird-fanciers'lung 495.3 Suberosis 495.4 Malt workers'lung 495.5 Mushroom workers'lung 495.6 Maple bark-strippers'lung 495.7 "Ventilation" pneumonitis 495.8 Other specified allergic alveolitis and pneumonitis 495.9 Unspecified allergic alveolitis and pneumonitis. Code for E/M and Other Procedures Separately "In pulmonary medicine, it is thought that 70 percent of the time the patient's history gives the diagnosis," Marinelli says. Apatient may present in your office with varying symptoms that could be confused with other respiratory problems, so the pulmonologist will usually take an in-depth history, perform a thorough exam and order several diagnostic tests.

For example, a 35-year-old male presents in the office with symptoms that include a cough (786.2), fever, fatigue and weight loss. Aphysical [...]