Pulmonology Coding Alert

With the ongoing reports of biological terrorism saturating the media, many pulmonologists are experiencing an onslaught of patients who think they may have contracted anthrax. 
 
"We've had a rash of such patients come in with vague symptoms," says Cynthia DeVries, RN, CPC, coding and reimbursement specialist with Lee Physicians, a 140-physician practice in Fort Myers, Fla. The symptoms of anthrax are similar to those of the flu: fever, muscle aches and fatigue. "Because it is curable if recognized and treated early enough, many people who develop these symptoms come rushing into the office fearing the worst," DeVries says.
 
Pulmonologists should use the final diagnosis code for ill patients with fears of anthrax. For example, a patient whose asthma was exacerbated by a cold comes in afraid he or she has anthrax poisoning. Code the visit with 460 (acute nasopharyngitis [common cold]) as primary and an asthma code (493.2) as secondary. Link both diagnosis codes to the appropriate E/M office visit code, 99201-99215.
 
Regardless of the patient's fears, practices should code for the original symptoms, says Carol Pohlig, RN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania. When patients present with respiratory problems, believing they have anthrax, use the symptoms as the primary code. For example, if a patient presents with shortness of breath but the physician finds no infection, code 786.05 (shortness of breath) and an office visit code.
 
Some patients who have no symptoms schedule a visit because they are worried they were exposed. When no problem is found, bill these visits with V65.49 (health advice, education; other specified counseling) linked with the proper E/M code. Because the pulmonologist will probably spend time counseling the patient and educating him or her about anthrax, practices can use V65.49 for these visits, Pohlig says. Medicare probably will not cover it, but some private payers may.  
 
Critical Care
In the rare case that a patient is confirmed as having anthrax, he or she would be admitted to the intensive care unit (ICU) of a hospital. If the pulmonologist takes over care of the patient and begins critical care immediately, the appropriate critical care code (99291-99292) should be used, depending on the amount of time spent. For example, a postal worker who worked in a facility in which anthrax cases have been documented is admitted to the ICU with respiratory distress (786.09) and a temperature of 102 degrees F (780.6). A chest radiograph indicates a right perihilar infiltrate (793.1) and a small pleural effusion (511.9).
 
She is started on multidrug therapy, including ciprofloxacin, which was changed to azithromycin after 24 hours. She had an elevated white blood cell (WBC) (288.8) count of 11,000 with 14 percent bands. A [...]