Pediatric Coding Alert

Question: If two pediatricians in the same group see the same office patient on the same day, is there a way to obtain reimbursement for both physicians?

Minnesota Subscriber

Answer: No, you would normally combine both E/M services into one code. CPT considers each day's history and physical to be global. Therefore, correct coding bundles same-day office visits together.

For instance, two pediatricians in the same practice treat an asthma patient twice on the same day. In the morning, Pediatrician A prescribes new asthma medication for a patient who has been having occasional attacks and codes the encounter as 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...). Later that day, the patient returns wheezing and sees Pediatrician B, who performs and documents 99214 with spirometric pre- and post-bronchodilator evaluations, repeat nebulizations and prolonged time.

If you submit 99213 and 99214 on the same day, the payer will reject one of the E/M services - usually the higher-paying office visit - as duplicative.

Better way: Combine the two physicians' work and submit one E/M code, such as 99215. You should also report Pediatrician's B procedures, such as:

a bronchospasm evaluation with 94060 (Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral])

repeat nebulizations as 94640-76 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device]; repeat procedure by same physician)

and prolonged services with +99354 (Prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service [e.g., prolonged care and treatment of an acute asthmatic patient in an outpatient setting]; first hour [list separately in addition to code for office or other outpatient evaluation and management service]) and possibly +99355 (... each additional 30 minutes [list separately in addition to code for prolonged physician service]).

If the pediatricians are in two different groups (not covering for each other), they should each bill the appropriate E/M service code. But insurers will require different ICD-9 diagnoses, such as controlled extrinsic asthma (493.01, Extrinsic asthma with status asthmaticus) and exacerbated asthma (493.02, Extrinsic asthma with [acute] exacerbation), for payment.