Pulmonology Coding Alert

Tracking cystic fibrosis (CF) patient counseling and coordination of care time during an office visit can boost E/M levels and, therefore, mean more reimbursement to your pulmonology practice.

According to CPT, when counseling and/or coordination of care takes up more than 50 percent of the pulmonologists face-to-face time with the patient, time may be considered the controlling factor to qualify for a particular E/M service level. The extent of counseling and/or coordination of care must be documented in the medical record, CPT states. Counseling time also includes time spent with the parties who have assumed responsibility for the patients care or decision-making. But remember, Medicare and most third-party payers do not pay for family education without the patient present.

The physician should document the total visit time and the actual time spent counseling/coordinating care. The physician should also comment on the important issues discussed with the patient in addition to any relevant clinical information, e.g., patient response. You should remember that only the physicians time spent counseling the patient can be counted toward counseling/coordination of care time. Time spent by the pulmonologists staff on the patients case is not reportable.

If the pulmonologist provides any E/M services during the same visit as he or she performs spirometry, sputum collection or other CF monitoring service, you should append the E/M code with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Separate diagnoses, when possible, also help to distinguish the services as distinct.