Pulmonology Coding Alert

Question: The pulmonologist goes to the hospital to examine a new patient who has been coughing up more mucus and complaining of increasing breathing difficulties. After a level-three E/M, the physician decides to test for emphysema. The pulmonary function laboratory performs spirometry with bronchodilator and a carbon monoxide diffusing capacity (DLCO). After examining the results of the pulmonary function tests, the physician diagnoses pulmonary emphysema. How should I report the encounter?

Tennessee Subscriber

Answer: Report the E/M with the patient's presenting symptoms, and report the procedures with the emphysema diagnosis.

On the claim, report the following:

• 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) for the bronchodilator
• 94720 (Carbon monoxide diffusing capacity [e.g., single breath, steady state]) for the CO2 test
• 491.21 (Obstructive chronic bronchitis, with emphysema; with [acute] exacerbation) linked to 94060 and 94720 to represent the patient's emphysema
• modifier 26 (Professional component) linked to 94060 and 94720 to show you are coding for the professional portion of these services.
• 99223 (Inpatient hospital care, per day, for the evaluation and management of a patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision- making of high complexity) for the E/M
• 786.2 (Cough) and 786.09 (Dyspnea and respiratory abnormalities; other) linked to 99223 to represent the patient's symptoms.

Keep in mind that the hospital will bill for the technical charges related to the spirometry with bronchodilator (94060-TC, Technical component) and the DLCO (94720-TC) services.