Bronchospasm occurs when the muscles that line the airways (bronchi) in your lungs tighten and contract. When these muscles tighten, your airways narrow, and cause difficulty in breathing along with frequent coughing and wheezing (a high-pitched whistling sound). Narrowed airways won’t let as much air to come in or go out of your lungs. This in turn may limit the amount of oxygen that enters your blood and the amount of carbon dioxide that leaves your blood. This condition commonly affects people with asthma. However, not everyone with bronchospasm has asthma. Medical billing and coding for bronchospasm is quite challenging. Healthcare practices treating patients suffering from bronchospasm need to know the correct medical codes to report the condition on the medical claims. Outsourcing medical billing and coding is a feasible strategy for accurate and timely claim filing for appropriate reimbursement.
Any swelling, irritation, inflammation, or allergic reaction of the airways can cause bronchospasm. Other factors that can contribute to this disorder include – allergens, chronic obstructive pulmonary disease (COPD), infection of the lungs or airways, exercise, cold weather, smoke inhalation (from a fire or use of tobacco and illicit drugs) and general anesthesia during surgery. Typical symptoms include wheezing, chest pain or tightness, coughing and fatigue.
Diagnosing and Treating Bronchospasm
Under most circumstances, primary diagnosis of this condition will begin with a detailed medical examination. A primary care physician or pulmonologist (who treats lung diseases) will conduct a detailed physical examination wherein they will ask about the patient’s symptoms to check whether he/she has any history of asthma or allergies. They will also check the heartbeats as the patient breathes in and out.
Physicians may recommend lung function tests such as spirometry, lung diffusion capacity, pulse oximetry, lung volume test and Eucapnic voluntary hyperventilation to measure how well the lungs work. If the physician is concerned about other causes of wheezing or shortness of breath, they may also recommend other diagnostic imaging tests like chest X-ray and CT scan to look for problems and other signs of infection in the lungs.
Treatment for this condition generally begins with inhaled medications known as short-acting beta2-agonists. Ventolin or Proventil (albuterol) are common medications that may be used if the patient has difficulty in breathing or shortness of breath. Long-acting bronchodilators like Albuterol help keep airways open for up to 12 hours. Inhaled steroids and oral or intravenous steroids may be prescribed if the bronchospasm is severe. People who suffer from exercise-induced bronchospasm can take short-acting medicines about 15 minutes before they start the workout. Antibiotics will be prescribed for patients who have a bacterial infection.
The diagnosis, screening tests and other procedures performed by pulmonologists or other physicians must be carefully documented using the correct medical codes. Medical billing and coding services ensure this so that claim denials are avoided. Medical codes used for this respiratory disorder include –
- J98 – Other respiratory disorders
- J98.0 – Diseases of bronchus, not elsewhere classified
- J98.01 – Acute bronchospasm
- J98.09 – Other diseases of bronchus, not elsewhere classified
- 94010 – Spirometry, including graphic record, total and timed vital capacity, expiratory flow measurement(s), with or without maximum voluntary ventilation.
- 94011 – Measurement of spirometry forced expiratory flows in an infant or child through 2 years of age.
- 94012 – Measurement of spirometry forced expiratory flows, before and after bronchodilator, in an infant or child through 2 years of age.
- 94013 – Measurement of lung volumes (i.e., functional residual capacity (FRC); forced vital capacity (FVC), and expiratory reserve volume (ERV) in an infant or child through 2 years of age.
- 94014 – Patient-initiated spirometry recording per 30 day period of time; includes reinforced education, transmission of spirometry tracing, data capture, analysis of transmitted data, periodic recalibration and review and interpretation by a physician or other qualified health professional.
- 94015 – Patient-initiated spirometry recording (includes hook-up, reinforced education, data transmission, data capture, trend analysis, and periodic recalibration).
- 94016 – Patient-initiated spirometry review and interpretation only by a physician or other qualified health professional.
- 94060 – Bronchodilator responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration.
- 94070 – Bronchspasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (eg. antigen(s), cold air, methacholine).
- 94150 – Vital capacity, total (separate procedure).
- 94200 – Maximum breathing capacity, maximum voluntary ventilation
- 94250 – Expired gas collection, quantitative, single procedure (separate procedure).
- 94375 – Respiratory flow volume loop
- 94617 – Exercise test for bronchospasm, including pre- and post- spirometry, electrocardiographic recording(s), and pulse oximetry
- 94618 – Pulmonary stress testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed
- 94621 – Cardiopulmonary exercise testing, including measurements of minute ventilation, CO2 production, CO2 uptake, and electrocardiographic recordings
- 94726 – Plethysmography for determination of lung volumes and when performed, airway resistance.
- 94727 – Gas dilution or washout for determination of lung volumes, and when performed distribution of ventilation and closing volume.
- 94728 – Airway resistance by impulse oscillometry
- 94729 – Diffusing capacity (eg. Carbon monoxide, membrane)
- 94750 – Pulmonary compliance study (eg. Plethysmography, volume and pressure measurements).
- 94760 – Noninvasive or pulse oximetry for oxygen saturation, single determination.
- 94761 – [Oximetry] multiple determinations (eg. During exercise).
- 94762 – [Oximetry] by continuous overnight monitoring (separate procedure).
- 94799 – Unlisted pulmonary service or procedure.
- 95012 – Nitric oxide expired gas determination.
- 95070 – Inhalation bronchial challenge testing (not including necessary pulmonary function tests); with histamine, methacholine or similar compounds.
It is important to seek emergency help if the patient experiences shortness of breath or breathing difficulty. Following the first incidence, it is essential to develop a definite plan of care that may help reduce the patient’s risks of suffering subsequent episodes of bronchospasm. These include – warming up for at least 5 to 10 minutes before exercise, consuming lots of water throughout the day (to loosen up any mucus in your chest), quitting the habit of smoking or staying away from smoke and reducing the chances of allergies.
Medical billing and coding for bronchospasm can be complex, as there are several codes associated with the condition. By outsourcing these tasks to a reliable and established anesthesiology medical coding company or other medical coding service provider (that offers the services of AAPC-certified coding specialists), healthcare practices can ensure correct and timely medical billing and claims submission.