Medicare Compliance & Reimbursement - 2009 Issue 3
Reader Questions: Combo Codes Mark COPD With Other Conditions
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Article Overview
This reader Q&A explains how an emergency department encounter involving shortness of breath, coughing, spirometry, and a COPD-related diagnosis was coded and why the claim issue arose. It is useful for ED coders, outpatient coding staff, and audit-focused reviewers who work with E/M services, respiratory testing, and diagnosis coding conventions. The article also discusses how the encounter should be viewed from a general coding perspective and how a single diagnosis code may be used when COPD and bronchitis are documented together.
Why This Topic Matters
The topic is relevant because it shows how billing for diagnostic testing, ED visit complexity, and diagnosis selection can affect claim acceptance and coding accuracy. It also helps coders understand how combo diagnosis reporting is discussed in legacy ICD-9 coding contexts.
Article Sections
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Question
A reader describes an emergency department visit involving respiratory symptoms, pulmonary testing, and a denial question tied to the submitted claim.
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Answer
The response addresses the billing issue at a high level and discusses how the testing and ED service are considered together.
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Benefit
This section explains the broader effect on the ED visit level when the overall service work supports a different E/M selection.
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ICD-9 coding
The article shifts to diagnosis coding guidance in an older ICD-9 context for documenting COPD with bronchitis.
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Note
A final note clarifies the relationship between the combined diagnosis code and a separate acute bronchitis code in the example discussed.
What You Will Learn
- How the article frames an emergency department spirometry billing question
- How ED evaluation and management level selection is discussed in relation to additional work
- How COPD and bronchitis are addressed in legacy diagnosis coding guidance
- How the article presents the use of a combined diagnosis code in an ICD-9 context
Who Should Read This
- Emergency department coders
- Physician billing staff
- Outpatient coding professionals
- Coding auditors and compliance reviewers
Codes Discussed
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