Pulmonology Coding Alert

An underlying chronic condition may be creating a problem in a body system apart from the obvious. Therefore, you may examine (and be reimbursed for examining) an established patient with a chronic condition for evidence of health problems in other body systems, without considering such examination a screening, even though screening techniques and modalities may be used.

Carol Pohlig, BSN, RN, CPC, at the University of Pennsylvania Department of Medicine in Philadelphia believes, It is wrong to assume that there is nothing else wrong with a patient who is being treated for a chronic condition and that any other system examination is a screening. She says that the presence of a chronic condition, in itself, prohibits defining all tests for other body parts as screenings. Chronic conditions tend to be systemic, she says. They can easily affect other parts of the body.

As an example, Pohlig says that hypertension (401.9, essential hypertension; unspecified) can affect many systems. She says that although technically the patients other systems have not been affected by the illness, this is not the proper understanding of a screening examination. You could say that although the patient doesnt have an illness, hypertension can constrict the veins and the arteries so much that it can cause a decrease in renal perfusion, which can affect kidney output. Therefore, a genitourinary examination is not a screening, but an examination to determine the progression of hypertension. Suppose the physician needs to examine the legs, hands and feet for peripheral vascular problems (such as 443.9, peripheral vascular disease, unspecified) that were caused by hypertension, Pohlig says. This is not a pure screening the way Medicare looks at screening, which is as an absence of illness. She says a better example of screening is a colonoscopy for colorectal cancer (G0105) for the hypertensive patient. In that situation, the physician is examining the gastrointestinal organ systems for a disease that is not present.

Other Body Systems May Be Affected by the Chronic Condition

Performing a comprehensive examination for an established patient with a new chronic illness isnt necessarily screening, either, Pohlig says. I think that separating that from a true screening visit implies that you wouldnt have a diagnosis.

Pohlig says that looking at body systems other than those affected by a chronic systemic disease is simply part of a good clinical evaluation. It makes medical sense, she says. If you dont examine these other parts of the body when looking at the progression of the disease, you could have other medical/legal issues involved. This is not screening in the sense of preventive medicine codes.

Pohlig observes that now, more than any other time, there are more Medicare patients who [...]