Pulmonology Coding Alert

Answer: You could look for granuloma in the alphabetical list of the ICD-9 manual, and under granuloma look for lung. This would lead you to code 515. When you refer to the tabular list, youd find that 515 specifies any type of postinflammatory pulmonary fibrosis fibrosis and scarring of the lungs due to inflammatory reaction.

But this is a case where you need to check with the physician because this diagnosis is unlikely to be the final one. The physician almost certainly will remove the nodule and find out what it is. He or she knows that its hard to hit all these nodules with a bronchoscopy, so the next step would probably be a pleuroscopic biopsy to produce a larger tissue sample. The final diagnosis could turn out to be quite different.

In the interim, you could use the diagnosis code that covers a nodule on a chest x-ray, 518.89 (other diseases of lung, not elsewhere classified), until the physician affirms the final diagnosis. Once you enter a diagnosis code, it stays with the patients permanent record, so its important to be sure your entry is correct, even if it means you have to incur a delay to take the time to recheck with the physician.

You Be the Coder is answered by Walter J. ODonohue Jr., MD, FCCP, representative to the American Medical Associations (AMA) CPT advisory committee for the American College of Chest Physicians and chief of pulmonary/critical care at the University Medical Center in Omaha, Neb.