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Pulmonology Coding Alert

Diagnosis Coding:

480-486: Careful Pneumonia Coding Keeps Provider-Payer Relationship Healthy

Published on Mon Feb 28, 2011

See why you should wait for physician's final diagnosis before settling for a code.Pneumonias are differentiated by clinical findings and findings on physical examination, and coding the specific condition could be risky. If a claim confirms pneumonia for a patient who presented with symptoms, would you know what to do with the results? Consider this scenario:A patient sees a pulmonologist who orders a chest x-ray because of a persistent cough. The result of the chest x-ray indicates the patient has pneumonia. A pulmonologist performs a sputum culture, and confirms the Eaton's agent pneumonia -- a type of pneumonia caused by the organism mycoplasma pneumoniae. The interpreting physician should report a primary diagnosis of pneumonia.Easy? Not so fast. The ICD-9 lists several classifications of pneumonia that covers 480-486 of the manual. Overuse of the diagnosis codes for specified bacteria has, in fact, been rampant among coders of pulmonology. Don't be part of [...]
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