Coding for Cystic Fibrosis Patients

Cystic Fibrosis Diagnosis and Treatment Coding, Coding for Cystic Fibrosis, 2016 ICD-10-CM Diagnosis Code E84.9, Diagnosis sequencing in cystic fibrosis

The genetic disease cystic fibrosis isn’t all that common — according to surgeon and public health researcher 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.

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 pulmonologist’s 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 don’t have the disease itself, but when both parents are CF carriers, chances are 25 percent that the child will have cystic fibrosis.

What About You?

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

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About 

Susan taught health information and healthcare documentation at the community college level for more than 20 years. She has a special love for medical language and terminology. She is passionate about ensuring accurate patient healthcare documentation through education. She has a master's degree in healthcare administration, is a certified healthcare documentation specialist, and serves as immediate past president for the Association for Healthcare Documentation Integrity (AHDI).

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