Pulmonology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer. Question: A pulmonologist performs multiple arterial blood gas (ABG) interpretations within a 24-hour period only when levels are abnormal. He continues ABG readings until the findings are normal. Which ICD-9 code should we use for interpreting the normal ABGs? Should we use the chief complaint or symptom for which the patient was originally tested?

Missouri Subscriber Answer: A pulmonologist uses ABG measurements (82800-82803) primarily to detect problems with ventilation or oxygenation (786.09) that can manifest into associated conditions such as acid-base disturbances. If the initial reason for performing an ABG, such as dyspnea (786.09) or hyperventilation (786.01), continues to persist when the physician orders the subsequent ABG test, you should continue reporting that initial diagnosis code in addition to the underlying condition causing the dyspnea or hyperventilation, e.g., pneumonia, 486.

If the initial ABG confirms the presence of an abnormality (e.g., respiratory alkalosis, 276.3), report this more specific condition as the primary reason for subsequent ABGs, in addition to the previously mentioned signs, symptoms and conditions if they remain applicable.

CPT does not have a code for interpreting ABGs because CMS prohibits billing for this service. Consequently, you should use time spent reviewing ABGs, x-rays and other laboratory data when documenting the level of complexity for the E/M service(s) billed.