LOCATION: Outpatient, Hospital
PATIENT: Kim Fields
PHYSICIAN: Gregory Dawson. MO
ENTRANCE DIAGNOSIS: Dyspnea on ascending hills and stairs. Frequent wheezing and productive cough in a patient with a 0.75-pack-year smoking history; quit 1 year ago. Gave good consistent effort.
I. Baseline spirometry is normal with maybe a hint of concavity towards the volume axis at the terminal portion of the curve. The spirometry does show only a 61% FEF2S-7S indicating peripheral dysfunction, i.e., mild COPD/emphysema. II. Baseline FEVI of 3.02. which was 84% of predicted dropping to a low of 1.33 after only 24.5 cumulative units of methacholine. Five minutes later it was 1.78, both values, which are greater than 20% drop from baseline.
III. Baseline FEV25-75 was 2.50 dropping to 0. With the provocation doses 5 minutes later it was 0, both values which are greater than a 50% drop from baseline. IV. Ten minutes after bronchodilator, FEV1 rose to 2.89. The FEV25-75 rose to 2.12. OVERALL IMPRESSION: This study demonstrates bronchial hyperactivity as well as reversibility with a clinical diagnosis of asthma. It would be interesting to see if this patient can turn her baseline to normal after a good month of intense bronchodilator therapy. She may have some underlying peripheral airway dysfunction from poorly controlled asthma and/or smoking. It would be nice to see what it is when she is as well controlled as we can get her.
CPT SERVICE CODE(S):___________________________________
ICD-9-CM DX CODE(S): ________________________________
Selected Answer: [None Given]
Professional Services: 94060-26 (Pulmonology, Diagnostic, Spirometry, Evaluation), 94720-26 (Pulmonology, Diagnostic, Carbon Monoxide Diffusion Capacity), 94260-26 (Pulmonology, Diagnostic, Thoracic Gas Volume), 94360-26 (Pulmonology, Diagnostic, Resistance to Airflow) ICD-9-CM DX: 493.90 (Asthma/asthmatic), V15.82 (History, tobacco use) This study is a pulmonary function study to measure a patient's ability to breathe. Multiple codes are required to report this service. Code 94060 is used to report the pre and post bronchodilator administration. Code 94720 is used to report the carbon dioxide diffusing capacity testing and code 94360 to report the resistance to airflow. Modifier -26 is added to each of the codes, as the directions indicated that only the physician (professional) portion of the service was being provided. The test was done to see the progression of the patient's asthma, 493.90. The code V15.82could also be coded out to show the history of tobacco use.
PREOPERATIVE DIAGNOSIS: Hemoptysis.
POSTOPERATIVE DIAGNOSIS: Mucosal lesion of bronchus.
OPERATION PERFORMED: Bronchoscopy.
The bronchoscopy was passed through the nose. The vocal cords were identified and appeared normal. No lesions were seen in this area. The larynx and trachea were then identified and also appeared normal with no lesions or bleeding. The main carina was sharp. All bronchial segments were visualized. There was an endobronchial mucosal lesion. This was located on the right lower lobe of the bronchus. The lesion was occluding the right lower lobe of the bronchus. No other lesions were seen. With use of fluoroscopic guidance, transbronchial biopsies were taken of the area of the lesion. Brush washings were also done for cytology analysis. The patient tolerated the procedure well and was sent to the recovery area in stable condition. CPT SERVICE CODE(S): ___________________________________
ICD-9 CODE(S): __________________________________________
Selected Answer: [None Given]
PROFESSIONAL SERVICES: 31628 (Bronchoscopy),
31622-59 (Bronchoscopy, diagnostic, separate procedure).
ICD-9 DX CODE: 239.1...