What You Need to Know
Pulmonology coders will finally be able to report various asthma and chronic bronchitis conditions with greater specificity - thanks to new and revised ICD-9 codes that take effect Oct. 1. CMS unveiled the new diagnosis codes, several of which affect pulmonology practices, in the May 19 Federal Register.
The new and revised asthma diagnosis codes have something in common: more precise fifth-digit definitions.
Medicare focused on asthma for many of its pulmonology-related updates because asthma is a high-profile condition for patients, physicians and payers, says Anthony M. Marinelli, MD, FCCP, chairman of the American Thoracic Society's Clinical Practice Committee. Someday, CMS and other carriers may use the data from ICD-9 reports to adjust payments or develop quality guidelines. That's why your pulmonology practice should be as accurate as possible when you report diagnosis codes to avoid a potential fraud or abuse issue, he adds.
Link CVA Diagnosis With Bronchodilator Treatment You will have several new respiratory diagnosis codes to choose from in 2004. CMS will add cough variant asthma (CVA) (493.82), a form of asthma with a chronic cough, and acute chest syndrome (517.3), which is most often associated with sickle-cell disease.
For example, your pulmonologist might report a CVA diagnosis if a patient presented with a chronic cough (786.2) lasting longer than three weeks, although the patient showed no other asthmatic symptoms, such as shortness of breath (786.05) or wheezing (786.07), says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.
Typically, your physician can choose from several carrier-approved procedures to test for CVA. For instance, your pulmonologist tests the patient with bronchodilators (94640, Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]) and performs a bronchial challenge (95070, Inhalation bronchial challenge testing [not including necessary pulmonary function tests]; with histamine, methacholine, or similar compounds). He or she finds eosinophilic inflammation (518.3), and rules out CVA. You would report the diagnostic tests and the eosinophilic diagnosis.
Your physician will most likely encounter acute chest syndrome in patients with sickle-cell anemia. For example, a sickle-cell patient presents to your office with a number of signs and symptoms: chest pain (786.5x), cough (786.2), progressive anemia (285.9), hypoxemia (799.0) and new infiltrates found on x-ray (793.1, Lung field). The patient may have fever (780.6), as well.
When your pulmonologist diagnoses a patient with severe acute respiratory syndrome (SARS), you will be able to report a specific SARS-related condition, as opposed to only signs and symptoms. Medicare has introduced three new SARS codes: 079.82 (SARS-associated coronavirus), [...]
