Pulmonology Coding Alert

Using signs-and-symptoms codes makes all the difference

Don't get lost in a sea of ICD-9 codes that your pulmonologist reports while examining a patient for suspected hypersensitivity pneumonitis. Refer to the list of procedure codes and definitions below to help you link the signs and symptoms codes to the right procedure. Bronchoscopies  31622 -- Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing (separate procedure)
 31623 -- ... with brushing or protected brushings
 31624 -- ... with bronchial alveolar lavage
 31625 -- ... with bronchial or endobronchial biopsy(s), single or multiple sites
 31628 -- ... with transbronchial lung biopsy(s), single lobe. Pulmonary Function Tests (PFTs)  94010 -- Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation
 94240 -- Functional residual capacity or residual volume: helium method, nitrogen open circuit method, or other method
 94375 -- Respiratory flow volume loop
 94720 -- Carbon monoxide diffusing capacity (e.g., single breath, steady state). Use This Real-Life Coding Example What to do: Suppose prior to establishing an official diagnosis, the pulmonologist uses a bronchoscopy with brushings (31623, Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with brushing or protected brushings) to check for hypersensitivity pneumonitis. The patient, whose occupation has exposed him to environmental antigens, presented with chest pain (786.50), fatigue (780.79), and fever (780.6). Therefore, the physician would link these conditions to 31623 to support medical necessity.