Pulmonology Coding Alert

Experts show when to choose 99219 instead of 99214 Reporting established patient codes 99212-99215 when your pulmonologist evaluates a patient during observation care could be costing your practice $70 a session. To earn the reimbursement you deserve, you should choose hospital observation codes 99218-99220 when appropriate. Understand When to Use 99219 You should report hospital observation codes (for example, 99219, Initial observation care, per day, for the evaluation and management of a patient ...) when your pulmonologist admits the patient to observation, maintains responsibility for that patient during the stay, and provides the initial E/M service, says Beverly Roy, CPC, CCP, a professional coder at Summit Medical Associates, a multi-specialty medical facility that offers pulmonary and internal medicine care in Hermitage, Tenn.

Key points: When the physician sees the patient in observation but is not managing the patient's care, you must report the appropriate outpatient codes (for example, if the physician treats an established patient, use the 99212-99215 series).

Example: A patient presents to the physician with chest pain (786.5x) and wheezing (786.07). Suspecting emphysema 492.8 (Other emphysema), the pulmonologist sends the patient to a hospital's observation unit. If your physician evaluates the patient during observation that same day, and he assigns that patient to observation status, you should report 99218 (Initial observation care ...). Observation care includes "all evaluation and management services provided by the supervising physician" while the patient is in observation status on the same day of service, according to CPT 2004.

The bottom line: By capturing this service correctly, you can expect higher reimbursement than if you had assigned 99214, for example. Medicare pays $115 for 99219, based on national averages, but Medicare pays only $86 for 99214 (Office or other outpatient visit for the E/M of an established patient ...). Know How to Document the Initial Observation To best document the observation, include the following in the medical record:

 the date and time the observation began
 the treatment the physician will provide while the patient is in observation (for example, 94060, Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]) 
 nursing and progress notes prepared by the physician while the patient was in observation status, in addition to any record prepared as a result of an emergency department or outpatient clinic encounter. Count Hours for Same-Day Admits, Discharges The keys to choosing the right code in this situation are to count the hours the patient stays in observation, the time of admission and discharge, and the date of service, Roy says.

Careful: If the patient stays in observation status for less than eight hours on the same day, you should report 99218-99220. Also, you can't report discharge code 99217 (Observation care discharge day management) for observations [...]