Pulmonology Coding Alert

For specificity's sake, superbill must contain 209.xx, 511.8x and 997.3xIf you don't get your 2009 ICD-9 coding down pat, come this fall you'll be in the wrong category for malignant lung tumors and pleural effusions. Our experts walk you through the can't-live-without pulmonology code changes in store for you.ICD-9 has released its preliminary list of new diagnosis codes for late 2008 and 2009. Since HIPAA's passage, there is no grace period for new ICD-9 codes. You've got to be ready to go with the new codes on Oct. 1, says Joan Gilhooly, CPC, CHCC, president of Medical Business Resources in Chicago.The AMA has approved the following codes for use, but slight changes are possible before the list is finalized over the summer. For all the latest news on ICD-9 2009, check out future issues of Pulmonology Coding Alert.Break Bronchus/Lung Tumor Out of Group This FallCoders will be able to achieve greater specificity on carcinoid lung tumor diagnoses this fall, when ICD-9 rolls out 209.21 (Malignant carcinoid tumor of the bronchus and lung) and 209.61 (Benign carcinoid tumor of the bronchus and lung).These additions will end the practice of scrambling to different code sets for carcinoid tumor diagnoses, depending on the tumor type.Old way: Coders now report 162.9 (Malignant neoplasm of trachea, bronchus and lung; bronchus and lung, unspecified) for malignant lung/bronchial tumors unless the notes indicated a specific section of the bronchus, says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.For benign tumors, coders choose 212.3 (Benign neoplasm of respiratory and intrathoracic organs; bronchus and lung), regardless of specified area, she says.That all changes Oct. 1, when 209.21 and 209.61 go into effect. You'll often use these diagnoses on your lung biopsy claims, says Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta. These could be repeat biopsies in which you already have a diagnosis, or initial biopsies in which the physician is unsure of the patient's status.Example: The pulmonologist performs bronchial biopsies on a mass in a patient's upper bronchus. Pathology reports come back indicating a malignant carcinoid tumor.Beginning Oct. 1, report the following:• 31625 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with bronchial or endobronchial biopsy[s], single or multiple sites) for the bronchoscopy.• 209.21 linked to 31625 to represent the tumor.Remember to wait for the biopsy results before choosing 209.21 or 209.61. You don't want to code a patient's tumor as malignant when it is benign -- or vice versa.Update Cancerous Pleural Fluid Diagnosis CodingICD-9 2009 will also bring changes to the pleural effusion code set (511.xx). The new code [...]