Pulmonology Coding Alert

Question: Our pulmonologist recently evaluated an established patient in the office with AERD. How should we code the office visit? What is AERD and which are best diagnostic codes available for reporting the condition?

Washington Subscriber

Answer: For the established patient visit, you can report any of the E/M codes from 99212-99215 (family, depending upon the level of medical decision making [MDM] and time spent in the counseling of the patient).

Aspirin-exacerbated respiratory disease (AERD) is a condition where patients display four concurrent symptoms (also known as a tetrad) of nasal polyps, chronic hypertrophic eosinophilic sinusitis, asthma, and sensitivity to any dosage of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin and most NSAID medication in such patients may lead to different kinds of upper and/or lower respiratory reactions including rhinitis, conjunctivitis, laryngospasm, or bronchospasm. AERD, which you may also see described by your physician as Samter’s triad, aspirin induced asthma, aspirin sensitive asthma, or aspirin hypersensitivity affects almost 10-20 percent of asthmatics and up to 30-40% in chronic rhinosinusitis patients with asthma and nasal polyposis. According to studies, females have more predilection for conditions than males and the average age of onset is 34 years in a US study. The patients may present with onset of nasal congestion with anosmia and progression to chronic pansinusitis and nasal polyps. They may also complain of nocturnal nasal obstruction with sleep deprivation fatigue.

Upon presentation in the office, your pulmonologist will usually order CT and radiograms. The physician may rule out the diagnosis of AERD upon normal imaging of the sinuses. However, complete opacification in sinus imaging is observed in nearly all AERD patients. The gold standard test for AERD is oral aspirin challenge. Your physician may conduct this test in the office or a hospital-based setting because the test should be conducted in a properly controlled environment equipped for an immediate anaphylaxis intervention. You can report this test with code 94070 (Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents [e.g., antigen(s), cold air, methacholine]), which includes all spirometric measures performed on the same date of service. Upon positive diagnosis, your physician may recommend aspirin desensitization and therapy for best results.

You can append appropriate diagnostic ICD-9 code E980.0 (Poisoning by analgesics, antipyretics, and antirheumatics, undetermined whether accidentally or purposely inflicted). This code is an additional code to be used with a main diagnostic code indicating the primary nature of the condition such as 493.xx (Asthma), 471.x (Nasal polyps), etc. Under ICD-10, AERD will be described by code J70.8 (Respiratory conditions due to other specified external agents).