Pulmonology Coding Alert

In addition: Don’t forget the new Category II codes added for PQRS measures.

When your pulmonologist discusses with another physician over the phone or internet about a referred patient’s pulmonary problems, you’ll be able to report this in 2014 as four new codes have been added to describe this service.

(See Pulmonology Coding Alert, Vol. 14, No. 10, for more information on CPT^® changes that’ll apply to pulmonology coding next year)

Consultations Are Not Just a Thing of the Past

Effective Jan. 1, CPT^® will include four new codes that describe the work of two medical professionals who discuss a patient’s condition via phone or internet, as follows:

• 99446 (Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review)
• 99447 (… 11-20 minutes of medical consultative discussion and review)
• 99448 (… 21-30 minutes of medical consultative discussion and review)
• 99449 (… 31 minutes or more of medical consultative discussion and review).

“The interprofessional codes are interesting,” says Suzan Berman, MPM, CPC, CEMC, CEDC, manager of physician compliance auditing for West Penn Allegheny Health Systems, Pittsburgh, Penn. “More and more, the provider community is communicating with patients and each other via the internet through secure email lines, etc. These codes appear to be in recognition of these situations. It affords a physician the ability to provide a virtual consultation to another physician without having the patient come to all the different appointments.”

As noted, these new codes are consultative in nature, which means you must provide a written report back to the requesting physician to qualify for the code, as indicated by the phrase “including a verbal and written report” (emphasis added).

Example: A primary care physician (PCP) refers a patient whom he has been treating previously for gastroesophageal reflux disease (GERD) and asthma to consult with your pulmonologist for symptoms of increased weight loss, a decrease in lung function, worsening cough and blood-tinged sputum. The PCP is of the opinion that the pulmonary symptoms that the patient is currently experiencing is being caused as a complication of the GERD or asthma and needs your pulmonologist’s opinion.

Your pulmonologist reviews the patient’s history, medical records (provided by fax/email), diagnostic studies and medication regime.

Your pulmonologist then spends 20 minutes over the phone with the PCP discussing the treating physician’s observations and interpretations of tests. He also discusses further testing to rule out differential diagnoses such as Cystic Fibrosis.  .

What to report: Since your pulmonologist spent 20 minutes discussing the patient’s condition, you can report his services using 99447.

Restrictions: These codes are used for urgent situations of a complex nature where a timely response is needed.  “The patient may be new or established to the consultant, but these codes cannot be reported if the consultant has seen the patient in the last 14 days, or accepts an immediate transfer of patient care with subsequent provision of a face-to-face service within the 14 days of the interprofessional consultation,” says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania, Department of Medicine in Philadelphia.  “If the sole purpose of the conversation between the treating physician and the consultant involves transfer of care arrangements, these codes cannot be used.”

More questions: Note that these codes are time based codes. So, you’ll have to base your code selection on the amount of time that was spent for the discussion. Coders and consultants alike have many questions about these new codes.

 “I am a bit curious about why they are broken into time and how that time will be measured (reading, discussing, interpreting, further research, etc.). How will the time be documented?” Berman asks. “What will the reimbursement look like in comparison with having the patient actually come into the office?”

“The physicians will want to know if it is something they might be able to utilize,” says Chandra L. Hines, practice supervisor of Wake Specialty Physicians in Raleigh, NC, who echoes many coders interested in determining whether insurers will include payment for these codes, since they are consultations.

The biggest question involves reimbursement.  “As with many of the other non-face-to-face service, separate reimbursement is not permitted, particularly since there is no patient evaluation (remotely or in-person) involved,” reminds Pohlig.  “Providers will be anxiously awaiting CMS’ release of the 2014 Physician Fee Schedule to determine the fate of these codes.”

Editor’s note: Keep an eye on Pulmonology Practice Coding Alert for more on whether these are payable once the 2014 insurance fee schedules are released.

Add New Chest Wall Oscillation Code to PFT Code Range

In 2014, you will have a new code in the pulmonary diagnostic testing and therapy series 94010-94799 that you can use to report mechanical chest wall oscillation. So, if your pulmonologist or a respiratory therapist performs mechanical chest wall oscillation to facilitate lung function, you will report it with 94669 (Mechanical chest wall oscillation to facilitate lung function, per session).

Coding tip: From the descriptor of 94669, it seems that this code will not be a time based code and you will be reporting only one unit of the code once per session.

Don’t Miss Out on These New Category II Codes

CPT^® 2014 will also introduce these new Category II codes that are relevant to pulmonology coders for measuring PQRS.

• 1503F (Patient queried about symptoms of respiratory insufficiency (ALS)[AAN])
• 1504F (Patient has respiratory insufficiency (ALS)[AAN])
• 1505F (Patient does not have respiratory insufficiency (ALS)[AAN])
• 3758F (Patient referred for pulmonary function testing or peak cough expiratory flow (ALS)[AAN])
• 4550F (Options for noninvasive respiratory support discussed with patient (ALS)[AAN])

The introduction of new Category II codes will mean that your pulmonology practice will now have more options for reporting PQRS quality measures.