Pulmonology Coding Alert

n an effort to promote the highest levels of professional knowledge, service and ethics, the clinical coders and other health information management professionals who make up the American Health Information Management Association (AHIMA) have revised and released new Standards of Ethical Coding. In keeping with AHIMAs customary emphasis on extensive and continuing education, the new standards hold medical information professionals responsible not only for making moral decisions but also for keeping themselves, their colleagues, and even their employers abreast of the latest changes in coding regulations and practices. Now that governmental agencies are concentrating so heavily on uncovering fraud and abuse, physicians facing a random audit would do well to have on staff a coder who follows the AHIMA standards.

Greg Schnitzer, RN, CPC, CPC-H, CCS-P, vice president for coding compliance at CodeRyte Inc., a coding software firm in Bethesda, Md., says that AHIMAs guidelines are not legally enforceable, but they do provide a clear framework for professional comportment. Schnitzer observes that the standards are based on common sense. Their value is that they are an established, written document for professional conduct.

The complete set of 10 codes is available on the AHIMAs Web site at www.ahima.org.

Link Diagnosis Codes With Procedural Codes

AHIMA Guideline Number 2: Coding professionals in all healthcare settings should adhere to the ICD-9 coding conventions; official coding guidelines approved by the American Health Information Management Association, American Hospital Association, Health Care Financing Administration, and National Center for Health Statistics; the CPT rules established by the American Medical Association (AMA) and any other official coding rules and guidelines established for use with mandated standard code sets. Selection and sequencing of diagnoses and procedures must meet the definitions of required data sets for applicable healthcare settings.

Cynthia DeVries, RN, BSN, CPC, a coding coordinator with the Lee Physician Group, a 42-physician practice in Ft. Myers, Fla., teaches correct coding to physicians and their employees. She says standard number two demonstrates how important it is, with regard to securing appropriate reimbursement, to correctly link diagnosis codes with procedure codes.

DeVries illustrates, using the example of a patient diagnosed with pulmonary hypertension (416.0-416.9). The initial presentation constitutes an office visit (99211-99215, office or other outpatient visit for the evaluation and management [E/M] of an established patient). Suppose the patient also is having extreme shortness of breath due to a pleural effusion (511.9), DeVries says. The physician schedules a thoracentesis (32000). Both procedures should be reimbursed if the pleural effusion is linked with the thoracentesis and the hypertension is linked with the office visit. Append modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or [...]