Pulmonology Coding Alert

Question: A new patient reports to the pulmonologist complaining of shortness of breath and coughing. The pulmonologist performs a level five E/M, then orders a spirometry (the practice owns the spirometry equipment). Based on test results, the physician diagnoses chronic obstructive pulmonary disease (COPD) with acute bronchitis. When choosing ICD-9 codes, should I code the COPD and bronchitis separately? South Dakota Subscriber Answer: You should not report 466.0 (Acute bronchitis) for the obstructive chronic bronchitis because the code descriptor for 491.22 specifies acute bronchitis is present in addition to the chronic obstructive bronchitis. On the claim, report the following: • 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) for the spirometry • 491.22 (Obstructive chronic bronchitis; with acute bronchitis) appended to 94010 to represent the COPD • 99205 (Office or other outpatient visit for the evaluation and management [...]