Pulmonology Coding Alert

Question: The pulmonologist performed an outpatient bronchoscopy with bronchial biopsy (31625) on a patient with chronic obstructive pulmonary disease (COPD). After the procedure, the pulmonologist admitted the patient to the observation ward because of stridor and wheezing. He then performed a history and physical and discharged the patient on the same day. 

The pulmonologist found that the biopsy returned positive for lung cancer. How should I code his services?


Michigan Subscriber


Answer: You can use one of the hospital observation E/M codes (99234-99236, Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, which requires these three key components ...) to report the observation and care the pulmonologist performed on the same day. 

The level you choose depends on several factors, including whether the pulmonologist documented a detailed history or a comprehensive history, whether he completed a detailed or comprehensive physical, and the complexity of the decision-making.
 
Whichever code you do choose, you should attach modifier -25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) because the pulmonologist completed the bronchoscopy and an E/M service on the same day. 

If the patient had emphysema, you would link 491.21 (Decompensated obstructive bronchitis and emphysema) to the E/M code; otherwise report stridor (786.1) and wheezing (786.07). Report a lung cancer code (162.0-162.9, Malignant neoplasm of trachea, bronchus, and lung ...) with the bronchoscopy.