Pulmonology Coding Alert

After an ICD-9 code is reported on an insurance claim, it enters into the system as a lifetime record for that patient. Coding for tuberculosis (TB) is an excellent example of how this can be a serious problem. Insurers can penalize patients for a pre-existing condition they may not have or know theyve been labeled as having until they change insurance carriers and find it listed as a pre-existing condition.

A positive tuberculosis screening doesnt mean that the person has TB, so dont use a TB code, says Carol Pohlig, BSN, RN, CPC, of the University of Pennsylvania department of medicine in Philadelphia. Unless they are clinicians, most coders and billers do not understand the terminology used for TB codes. They may look for a word-for-word representation in the medical record that is not going to be there because the doctor does not know how it is stated in the ICD-9 book.

Dont label a patient with a positive tuberculosis screen by using the ICD-9 code for TB, Pohlig says. Instead, use the appropriate PPD (positive purified protein derivative of tuberculin) ICD-9 code. If you code it as TB, their insurance company has a record that says the person has TB and is now a liability. In other words, while a positive skin test may be from a TB infection, it may not mean they have TB. The appropriate positive ICD-9 code for this is 795.5 (nonspecific reaction to tuberculin skin test without active tuberculosis).

Coding a Definite TB Diagnosis

Coding a patient who tests positive for TB beyond a simple screening can be tricky. Using the fifth digit appropriately can be a big problem. Pohlig points out that coders cant just open the ICD-9 book and read the code because the physician isnt going to write in his notes identified positively through positive culture. He might write positive and then name the test, she says. To be able to use the fifth digit appropriately and to code to the highest level of accuracy the coder needs to be familiar with the methods of TB testing.

Scott Manaker, MD, interim vice chair of clinical affairs and director of clinical documentation at the department of medicine at the University of Pennsylvania in Philadelphia, says that the first step in accurately coding a TB patient is figuring out which organ the disease has invaded. He observes that the ICD-9 book has nine sets of TB codes from 010 through 018. If its extra-pulmonary, match it up to the appropriate code for the organ system, Manaker says. Look up the affected organ for extra-pulmonary TB. Whether it is TB of bones and joints (015), genital-urinary system (renal TB) (016), miliary TB (018) or something [...]