Pulmonology Coding Alert

Don't underestimate the value of one doctor asking another doctor for his opinion If your practice performs consults, make sure your pulmonologists' documentation includes the request for his opinion and his report back to the requesting physician. Consult documentation must align correctly with CMS and CPT guidelines, or else your pulmonologist's hard work will earn your practice less. Know Your Consult Codes CPT includes four types of consultation codes:
  office or other outpatient (99241-99245)
  initial inpatient (99251-99255)
  follow-up inpatient (99261-99263)
  confirmatory (99271-99275). When another practitioner requests your pulmonologist's opinion about a patient's condition, you should report a consult code.
 
Example: A patient with a chronic cough (786.2) and complaining of shortness of breath (786.05) presents to her primary-care physician (PCP).
 
After extensive testing, the PCP cannot establish a diagnosis and asks a pulmonologist to evaluate the patient and give his opinion regarding the patient's condition and possible treatment methods.
 
The pulmonologist examines the patient for and determines the patient may be asthmatic. Therefore,  the pulmonologist decides to perform a baseline spirometry test.
 
The spirometry reveals that the patient has decreased lung function consistent with asthma (493.xx). He administers a bronchodilator to relax the patient's bronchial tubes (94640, Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes) and retests the patient's pulmonary function. The pulmonologist sends the PCP a report with his diagnosis and his recommendation for follow-up.
 
Note: If the pulmonologist administers bronchodilator and spirometry on the same day, you should report 94640 and 94010 (Spirometry ...). You should report the second spirometric testing with modifier -76 (Repeat procedure by same physician) appended to the spirometry code   (that is, 94010-76).  

Coding advice: The pulmonologist's service qualifies as an office consultation, and you should report the appropriate code from the 99241-99245 range depending on time spent with the patient, key components, and level of problem severity, in addition to the other procedure codes (94010 and 94640). Transfers Define Referrals Without a request, you won't be expected to produce a report. A referral, on the other hand, is the transfer of responsibility for a patient's care from one physician to another, says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting in Denver.

Example: A 23-year-old woman with a slight fever (780.6) and productive cough (786.2) reports to her internist. The internist orders a chest x-ray, and the radiology report indicates that the patient may have pneumonia.

The internist refers the patient to a pulmonologist for treatment. Because the internist does not ask the pulmonologist to render an opinion on the patient's condition, the pulmonologist should code his service with a new patient office visit code (99201-99205).

"Doctors frequently say to patients things like, 'I'm going to refer you [...]