DB5 Question 1 Contains unread posts Erin Pickles posted Nov 14, 2023 1:38 PM Subscribe 1. A 62-year-old man comes into the practice where you work complaining of bronchospasm. Spirometry is administered before and after a bronchodilator to measure the patient’s lung capacity. How are these procedures coded? What pulmonary tests are included in a complete spirometry, and how are they coded? What must you take into consideration when coding spirometry? [Tips: Spirometry is a common breathing capacity procedure with many variations, coded in the range of 9401094070. Spirometry can be patient-initiated or performed in a laboratory. In patient-initiated spirometry, codes range from 94014-94016. A spirometry performed before and after the bronchodilator is reported with (Fill in the blanks, 940–). Bronchodilators are coded separately with (Fill in the blanks, 990–). Complete spirometry is coded as (Fill in the blanks, 940–). When coding spirometry, coders need to know whether the procedure is performed in a laboratory or is patientinitiated. Is this a complete procedure? Are there any other pulmonary function tests the physician requests?] The diagnosis for the 62-year-old man is bronchospasm, which is the formation of the lung due to a spastic contraction of the bronchial muscles. A spirometry, which gauges a patient’s capacity for breathing, was the standard approach he underwent. Spirometry is a highly effective test for the early identification of numerous lung illnesses. Both patient-initiated and laboratory-performed spirometry are available. The same measures are obtained by patient-initiated spirometry (9401494016), which transmits data collected from the patient’s location to the pulmonary laboratory over the phone. The codes available for laboratory-performed spirometry are (94010/94060), while patient-initiated ones are (9401494016). A 30-day period of imagery recordings, data analysis, machine recalibration on a regular basis, physician assessment and interpretation of results, and instructions on equipment use from the technician are all included in the patient-initiated procedure represented by the code (94014). Only the recording component is represented by (94015) along with code (94016) which is exclusively for the analysis and interpretation of the findings. When a bronchodilator is utilized with spirometry the code (94060) is used. Here, bronchodilators are given prior to as well as after the test in order to observe if the values rise following administration. Spirometry is then conducted. On the other hand, basic spirometry is represented by the code (94010). A variety of specifications including measures and values, with the delivery of irritating substances, for instance, cold air, are included in the basic spirometry test represented by the code (94070). Prior to using a bronchodilator, lung function is measured using pre- and post-bronchodilator measurements. This will have its own code, (99070). Module 5 Discussion Question 1 Contains unread posts McKenzie Rogman posted Nov 14, 2023 2:41 PM Subscribe 1. A 62-year-old man comes into the practice where you work complaining of bronchospasm. Spirometry is administered before and after a bronchodilator to measure the patient’s lung capacity. How are these procedures coded? What pulmonary tests are included in a complete spirometry, and how are they coded? What must you take into consideration when coding spirometry? [Tips: Spirometry is a common breathing capacity procedure with many variations, coded in the range of 94010-94070. Spirometry can be patientinitiated or performed in a laboratory. In patient-initiated spirometry, codes range from 94014-94016. A spirometry performed before and after the bronchodilator is reported with (Fill in the blanks, 940–). Bronchodilators are coded separately with (Fill in the blanks, 940–). When coding spirometry, coders need to know whether the procedure is performed in a laboratory or is patient-initiated. Is this a complete procedure? Are there any other pulmonary function tests the physician requests?] Spirometry is the most common pulmonary function tests. It measures lung function, specifically the amount and speed of air that can be inhaled and exhaled. It may be ordered for someone who is wheezing, short of breath, or has a cough. If you are just coding for spirometry, you would use 94010. If you are coding spirometry with bronchodilator you would then use the code 94060. When using these codes, better reimbursement happens when current symptoms are associated with the appropriate ICD9 code for asthma and/or COPD. In a complete spirometry, you will have a pulmonary screening and a complete pulmonary function test. The pulmonary screening measures pulmonary flows. It is performed in a physician’s office to determine the presence of disease and is also used for in-hospital, pre-general anesthesia evaluation of pulmonary status. The complete pulmonary function test is used to measure lung volumes, capacities, airway resistance, and diffusion. A screening spirometry is part of every complete pulmonary function test. The pulmonary screening is typically coded as 94010 or 94060. The complete test is coded as 94726 or 94727. When coding spirometry it is important to know the correct way to code a specific pulmonary test that falls into this category. There is a code(s) for spirometry tests, codes for lung volume tests, codes for diffusion capacity tests, and even for stress testing. It is vital that coders are accurately coding the correct procedure and what is actually being done or examined on/for the patient. It is also important to know, in order to code for spirometry, whether or not the procedure was patientinitiated or done in the laboratory. Module 5 Question 1 Contains unread posts Jill Heflin posted Nov 13, 2023 5:22 PM Subscribe A 62-year-old man comes into the practice where you work complaining of bronchospasm. Spirometry is administered before and after a bronchodilator to measure the patient’s lung capacity. How are these procedures coded? What pulmonary tests are included in a complete spirometry, and how are they coded? What must you take into consideration when coding spirometry? [Tips: Spirometry is a common breathing capacity procedure with many variations, coded in the range of 9401094070. Spirometry can be patient-initiated or performed in a laboratory. In patient-initiated spirometry, codes range from 94014-94016. A spirometry performed before and after the bronchodilator is reported with (Fill in the blanks, 940–). Bronchodilators are coded separately with (Fill in the blanks, 990–). Complete spirometry is coded as (Fill in the blanks, 940–). When coding spirometry, coders need to know whether the procedure is performed in a laboratory or is patientinitiated. Is this a complete procedure? Are there any other pulmonary function tests the physician requests?] Spirometry is a common test that measures the breathing capacity and has several variations. As seen in this case where the patient is complaining of bronchospasm, a physician would order a spirometry test as it is the best test for early detection of lung disorders. A spirometry test can either be performed in a laboratory (94010/94060) or be patient- initiated (94014/94060). When a patient has a spirometry test performed in a laboratory, a technician measures the patient’s breathing capacity. In regard to a patient- initiated test, the results are in the same measurement, but the data will need to be submitted via telephone transmission. The CPT code 94014 includes the technician instructing the patient on the use of the machine, graphic recordings, analysis of the data, periodic recalibration of the machine, and physician review and interpretation of the results for a 30-day period. In a patientinitiated test, the code 94015 represents the recording component only and 94016 is for the review and interpretation of the results only. A basic spirometry test is coded as 94010. A spirometry performed before and after a bronchodilator is reported with the code 94060. This test measures the lung capacity before and after the bronchodilator was administered to see if the values increased. The CPT code 99070 represents the bronchodilators only. A complete spirometry (94070) includes the following: flow volume loop; prebronchodilator flow rates; postbronchodilator values; maximal ventilation values. A physician would determine what is to be included in their complete pulmonary function test. Often a pulmonary function tests includes spirometry, lung volume determination, and diffusing capacity. Other examples of a pulmonary test that a physician may request includes Functional Residual Capacity; Thoracic Gas Volume; Diffusion Capacity of Carbon Monoxide; Airway Resistance. Koesterman, J. L., & Buck, C. J. (2021). Buck’s the next step: Advanced Medical Coding and Auditing, 2021/2022. Elsevier. Module 5 Question 1 Contains unread posts Pamela Nyagah posted Nov 13, 2023 7:24 PM Subscribe A 62-year-old man comes into the practice where you work complaining of bronchospasm. Spirometry is administered before and after a bronchodilator to measure the patient’s lung capacity. How are these procedures coded? What pulmonary tests are included in a complete spirometry, and how are they coded? What must you take into consideration when coding spirometry? [Tips: Spirometry is a common breathing capacity procedure with many variations, coded in the range of 94010-94070. Spirometry can be patient-initiated or performed in a laboratory. In patient-initiated spirometry, codes range from 94014-94016. A spirometry performed before and after the bronchodilator is reported with (Fill in the blanks, 940–). Bronchodilators are coded separately with (Fill in the blanks, 990-). Complete spirometry is coded as (Fill in the blanks, 940–). When coding spirometry, coders need to know whether the procedure is performed in a laboratory or is patient-initiated. Is this a complete procedure? Are there any other pulmonary function tests the physician requests?] In medical coding, spirometry is a crucial procedure to assess lung function and is coded carefully to accurately represent the service provided (Graham et al., 2019). In the scenario of a 62-year-old man undergoing spirometry before and after bronchodilator administration, specific coding rules apply. Spirometry Coding 1.Pre and Post Bronchodilator Spirometry: When spirometry is performed both before and after administering a bronchodilator, it is reported with code 94060. This code reflects the measurement of breathing capacity and the assessment of bronchodilator effectiveness. 2.Bronchodilator Administration: The administration of bronchodilators is coded separately. Typically, this service is captured using codes in the range of 99070 or specific J codes, depending on the medication used and the method of administration. 3. Complete Spirometry: A complete spirometry, which includes measurements like Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), and the FEV1/FVC ratio, is coded as 94010. This code encompasses the full scope of basic spirometry testing (Lamb, Theodore and Bhutta, 2020). Considerations for Coding Spirometry: When coding for spirometry, several factors must be considered to ensure accurate and appropriate billing: 1. Location and Type of Procedure: It’s important to distinguish whether the spirometry is performed in a laboratory setting or is patient-initiated. Laboratory spirometry’s are typically coded under the 94010-94070 range. In contrast, patient-initiated procedures, which involve the patient using a home spirometer over a period, are coded with 94014-94016. 2. Completeness of the Procedure: Coders need to ascertain if the spirometry performed is a complete procedure (94010) or a more specific test like pre- and post-bronchodilator testing (94060). The specific test performed will guide the appropriate coding. 3. Additional Pulmonary Function Tests: If the physician requests additional pulmonary function tests beyond basic spirometry, such as lung volume measurement (94240) or diffusion capacity (94729), these should be coded separately. Each test has its specific code, and accurate documentation is key to selecting the right one. 4. Documentation and Clinical Notes: Accurate and thorough documentation by the healthcare provider is crucial. This includes details about the procedure, the medications used, the reasons for testing (such as bronchospasm in this case), and any additional tests performed. Coders rely on this information to apply the most accurate codes. In conclusion, coding for spirometry involves a detailed understanding of the procedure, its variations, and the specific context in which it is performed. The correct application of codes like 94010, 94060, and others in the spirometry range ensures that the services are accurately represented and billed. Sources Graham, B.L., Steenbruggen, I., Miller, M.R., Barjaktarevic, I.Z., Cooper, B.G., Hall, G.L., Hallstrand, T.S., Kaminsky, D.A., McCarthy, K., McCormack, M.C., Oropez, C.E., Rosenfeld, M., Stanojevic, S., Swanney, M.P. and Thompson, B.R. (2019). Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. American Journal of Respiratory and Critical Care Medicine, 200(8), pp.e70–e88. doi:https://doi.org/10.1164/rccm.2019081590st. Lamb, K., Theodore, D. and Bhutta, B.S. (2020). Spirometry. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK560526/. Part #2 Contains unread posts Elizabeth Krueger posted Nov 13, 2023 11:45 AM Subscribe Module #5 Part #2 2. A 35-year-old man has undergone a nephrectomy for removal of a healthy kidney. Why would someone need this surgery, and what else must you know to code the procedure properly? Does the lack of disease to the kidney affect how you code the procedure? [Tips: Think about why would an individual donate a healthy kidney? Are the codes for the procedure affected by the condition of the organ? Was the surgery performed with an open approach (Fill in blanks, 50300- 503–) or a laparoscopic procedure (Fill in the blanks, 50543- 505–)?] A nephrologist specializes in the treatment of conditions of the kidney and has special education and training in kidney disease and dialysis therapy as well as transplantation. Nephrology is a subspecialty of internal medicine (369). A 35-year-old man has undergone a nephrectomy for removal of a healthy kidney. A nephrectomy is the partial or total removal of the kidney that may be performed due to disease. It is stated in this patient’s case his kidney is healthy, he is likely donating a kidney (a total removal). The procedure can be performed as an open approach (50220- 50240) or as a laparoscopic procedure (50543, 50545, or 50548, which include a donor nephrectomy). Urinary System subsection in the CPT manual includes the following categories: kidney, ureter (kidney to bladder), bladder, and urethra (bladder to external body). It is very important to know the anatomy of the urinary system when coding from the subsection. It is all too easy to report the wrong code, as all of the categories have many of the same types of subcategories. It is crucial to make certain you are in the correct category before assigning a code. Source Elsevier. (2020). Buck’s The Next Step: Advanced Medical Coding and Auditing, 2021/2022 Edition. Saunders. pp.371. Module 5 Question 2 Contains unread posts Tara Sepe posted Nov 14, 2023 10:32 AM Subscribe A 35-year-old man has undergone a nephrectomy for removal of a healthy kidney. Why would someone need this surgery, and what else must you know to code the procedure properly? Does the lack of disease to the kidney affect how you code the procedure? [Tips: Think about why would an individual donate a healthy kidney? Are the codes for the procedure affected by the condition of the organ? Was the surgery performed with an open approach (Fill in the blanks, 50300-503–) or a laparoscopic procedure (Fill in the blanks, 50543-505–)?] A nephrologist specializes in the treatment of conditions of the kidney and has certain education and training in kidney disease and dialysis therapy as well as transplantation. It is important to have an abundance of nephrologists in healthcare because kidney disease is so prevalent in today’s day and age. These are also not to be confused with urologists, who specialize in the diagnosis and treatment of conditions of the urinary system. They also specialize in male genitourinary conditions and often treat patients with prostatitis, benign prostatic hyperplasia, and prostate cancer. Nephrology is a subspecialty of internal medicine. A nephrectomy can either be a partial or total removal of one’s kidney. These are performed because of disease or when an individual is donating their kidney. The procedure can be performed using an open approach (50220-50240) or a laparoscopic procedure (50543, 50545, or 50548, which includes a donor nephrectomy). Overall, it is extremely important for physicians and coders to understand how a kidney procedure is performed, as well as the correct way to code the procedure. As we all know, coding correctly is crucial for the billing and reimbursement process as well as the organization as a whole. Reference Koesterman, J. L., & Buck, C. J. (2021a). Buck’s the next step: Advanced Medical Coding and Auditing, 2021/2022. Elsevier.
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