Primary Care Coding Alert

Question: Can you bill for diagnostic tests conducted at the same time as an office visit, or does the coding for the visit bundle the tests?

Anonymous IA Subscriber

Answer: Take the case of a 65-year-old established patient with congestive heart failure who visits her family practitioner because she is having trouble breathing. She has had the problem periodically for several years so the visit is not too complex. While she is in the office, the family practitioner decides to perform a chest x-ray and measure the volume of air entering and leaving the lungs.

The family doctor can code 99212 (office or other outpatient visit with a problem-focused history, problem-focused examination and straightforward medical decision-making), 71020 (radiologic examination, chest, two views, frontal and lateral), and 94010 (spirometry, including graphic record, total and time vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation).

Kent Moore, manager of reimbursement issues for the American Academy of Family Physicians (AAFP), says that many family practitioners believe they can code only for the office visit. He points to the following, from CPT 2000, which supports the separate codes for the diagnostic procedures:

The actual performance and/or interpretation of diagnostic tests/studies during a patient encounter are not included in the levels of E/M services. Physician performance of diagnostic tests/studies for which specific CPT codes are available may be reported separately, in addition to the appropriate diagnostic code.