Pulmonology Coding Alert

Question:My pulmonologist sees an established patient who complains of trouble in breathing, and frequent coughing. She tells the physician that it hurts when she breathes. During a level-three E/M service, the pulmonologist diagnoses obstructive chronic bronchitis without exacerbation, prescribes antibiotics, and sends the patient home. Should I bill all the presenting symptoms besides the bronchitis?Florida SubscriberAnswer:Only one diagnosis codes links to the E/M. In short, you don't need to code for the patient's presenting symptoms since the pulmonologist reached a diagnosis during the encounter. This is what you'd report on the claim:99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity ...) for the E/M.491.20 (Obstructive chronic bronchitis; without exacerbation) appended to 99213 to represent the patient's bronchitis.Otherwise, if [...]