Coding for Cystic Fibrosis Patients

By Susan Dooley

The genetic disease cystic fibrosis isnt all that common according to surgeon and public
healthresearcher Atul Gawande, MD, MPH, only about a thousand children are diagnosed each year in
the United States as having it. The Cystic Fibrosis Foundation says that 30,000 Americans currently live
with the condition, and more than half of them are adults. But this disease causes the mucus in the
bronchial passages to thicken, block airways, and create an environment that makes it easy for bacteria
to grow and infect the lungs, which means that pulmonology practices should know the ins and outs of
reporting the diagnosis and treatment of CF patients.
The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

Cystic fibrosis patients require unique treatment, including exercise, antibiotics, bronchodilators,
nebulized mucus-thinning medications, airway-clearing methods and devices, and regular chest physical
therapy (PT). Chest PT can be manual, requiring another person, often a parent, to manually strike or
percuss the chest several times a day or it can be mechanized using a device called a VEST that vibrates
or flutters when you blow into a device. Either way, chest PT shakes the mucus around in the airways to
make it easier to cough up.

Code Your CF Diagnosis as Specifically as You Can

The code family E84.0 through E84.9 covers cystic fibrosis. You could choose ICD-10-CM diagnosis code
E84.9 (Cystic fibrosis, unspecified), but because of the nature of the disease, complications like
pneumonia are common among CF patients. For that reason, if your physician sees a CF patient who is
showing pulmonary exacerbation, the clinician will order a direct sputum acid-fast stain and culture to
identify the mycobacterium infecting the lung. In this case, you can report E84.0 (Cystic fibrosis with
pulmonary manifestations) because the documentation narrative clearly stated pulmonary
exacerbation. Once the pathology comes back with an identified organism, the guidelines for this code
instruct you to use an additional code to identify any infectious organism present, such as Pseudomonas
(B96.5).

Does Your Practice Own CF Testing Equipment?

For careful followup of CF patients conditions, pulmonologists will send patients to undergo tests like
spirometry (94010- 94799, Pulmonary diagnostic testing and therapies), chest X-rays (71010,Radiologic
examination, chest; single view, frontal) and sputum smears and cultures (88160,Cytopathology, smears,
any other source; screening and interpretation). In these cases, you can only report the pulmonologists
review of the X-ray results in the medical decision-making portion of the E/M service (99201- 99215,
Office or other outpatient visit) for the patient. The facility and radiologist report the X-ray services.
Sometimes, though, pulmonology practices own the X-ray equipment used for imaging in the outpatient
clinic, in which case you can safely bill for the X-ray using radiologic examination codes (71010- 71035).

Reporting Genomic Testing for Cystic Fibrosis

CPT 2016 includes revised codes in the Genomic Sequencing Procedures and Other Molecular
Multianalyte Assays section, and one is relevant for cystic fibrosis (CF):

81412, Panel for Ashkenazi Jewish genetic disorders such as Bloom syndrome, Canavan disease,
cystic fibrosis,

You might also want to review the gene analysis range 81220 to 81224 for a useful code. As always,
check with payers, as not all will reimburse for this test. According to the Cystic Fibrosis Foundation,
people who are CF carriers dont have the disease itself, but when both parents are CF carriers, chances
are 25 percent that the child will have cystic fibrosis.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

What About You?

Have you had experience billing for cystic fibrosis treatment? If you have tips to share, please let us
know.

Speed Your Pulmonology Coding With a Customized Product!

Pulmonology Coder is built to make your pulmonary coding chores move faster and more efficiently. Of
course it gives you SuperCoders fabulous code search software, letting you simultaneously search
across CPT, HCPCS, and ICD-10-CM. But thats not all! Decrease your audit risk by using the CCI Edits
Checker and Endoscopic Base Codes to ensure the right coding combo. Submit cleaner, more compliant
claims with the Real-Time CMS 1500 Scrubber. And dont forget what may be the best feature of all
access to the library of code- and keyword-searchable articles from 14 coding survival guides, plus a
monthly subscription to Pulmonology Coding Alert. We can discuss how Pulmonology Coder can make a
positive impact on your practice, Contact us today!

Contact Us:
Name: Sam Nair
Title: Associate Director Enterprise Practice
Email: shyamn@codinginstitute.com
Direct: 704 303 8150

Desk: 866 228 9252, Ext: 4813

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com