Pulmonology Coding Alert

Question: A patient's primary care physician (PCP) contacts our pulmonologist and asks him to consult on a patient. The PCP admitted the patient to the hospital three hours ago suspecting a collapsed right lung, and called the pulmonologist in when the patient's condition worsened. After reviewing lab results and x-rays, the pulmonologist confirms the patient is suffering from a complete atelectasis of the right lung. The pulmonologist interviews and examines the patient, reviews the x-rays and laboratory data, and then performs a therapeutic bronchoscopy to remove a large mucus plug. Is this considered a consultation?

Wisconsin Subscriber

Answer: Yes, this is a consultation. If the PCP admitted the patient and the pulmonologist examined and interviewed the patient at the PCP's request -- as well as reviewed the laboratory values and chest x-rays and initiated the corresponding treatment plan -- then you can code a consult.

On the claim, report the following:

• 31645 (Bronchoscopy [rigid or flexible]; with therapeutic aspiration of tracheobronchial tree, initial [e.g., drainage of lung abscess]) for the bronchoscopy

• the appropriate-level inpatient consult code from 99251-99255. For instance, if the pulmonologist's notes indicate a level-four consult, report 99254 (Inpatient consultation for a new or established patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity)

• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) linked to the consult code to show that the consult and bronchoscopy were separate services.

• 518.0 (Pulmonary collapse) linked to 31645 and 99254 to represent the patient's collapsed lung due to atelectasis.