Pulmonology Coding Alert

Question: We see a lot of patients who work in dusty environments and the doctor often diagnoses extrinsic allergic alveolitis (EAA). How should we code the tests for this condition?

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Answer: EAA (also known as hypersensitivity pneumonitis) is an inflammation of the lungs caused due to repeated breathing of foreign substances, usually of organic origin (such as certain types of dust, fungus, or molds) by susceptible subjects. The condition, which is usually occupational, can lead to lung inflammation and acute lung disease upon long-term exposure. EAA induces a hypersensitivity response in the distal bronchioles and alveoli and subjects may present clinically with a variety of symptoms.

To eliminate other conditions and confirm a diagnosis of EAA, your pulmonologist will take many steps to diagnose this condition properly. Just diagnosing it outright as EAA may be a dangerous conclusion. The physician may recommend several pulmonary function tests (PFT), blood work, x-rays, etc. including:

• 31624 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage)
• 85025 (Blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count] and automated differential WBC count)
• 86001 (Allergen specific IgG quantitative or semiquantitative, each allergen)
• 94070 (Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents [e.g., antigen[s], cold air, methacholine]) for postexposure evaluation

The physician may also order additional tests, x-rays and diagnostic services, but always check the Correct Coding Initiative to determine which codes can and cannot be reported together. Remember to use the diagnosis code that represents the symptoms until the diagnosis of EAA has been confirmed.