Pulmonology Coding Alert

Pulmonologists may be responsible for the care plan oversight (CPO) of patients with lung diseases who are treated in a hospice or through home healthcare. For example, patients with emphysema (492.0-492.8) or chronic obstructive lung disease (COPD, 496) can be treated effectively in either setting. In these cases, pulmonology physicians would review lab results of these patients and discuss appropriate medication and treatment with the hospice or home health staff. Coding for these services is even more difficult in 2001 because Medicare no longer recognizes CPT codes 99375 and 99378 (see below for definitions). This year, HCPCS instituted temporary G codes G0181 and G0182 for billing CPO for 30 minutes or more in a calendar month. As a result, coders have two sets of codes to consider, the CPT codes to be used with private carriers and the G codes to be used with Medicare.

CPT Revisions Include Nonphysician Professionals

CPO includes the development and revision of the patients care plan, explains Mary Jean Sage, CMA-AC, president of Sage Associates, a practice management-consulting firm, and program director for Certified Medical Billing Associates (CMBA), Amoyo Grande, Calif.

The supervising physician needs to communicate with healthcare professionals such as nurses, pharmacists, and therapists. CPT broadened the scope of its codes in the 2001 manual to include these nonphysician professionals.

Code 99375 specifies the physician care of a patient in a home health agency (patient not present), in home, domiciliary, or equivalent environment (e.g., Alzheimers facility) requiring:

complex multidisciplinary care modalities involving regular physician development and/or revision of care plans

review of subsequent reports of patient status

review of related laboratory and other studies

communication (including telephone calls) for purposes of assessment or care decisions with other healthcare professionals and nonphysician professionals involved in the care, integration of new information in the medical treatment plan and/or adjustment of medical therapy, within a calendar month, of 30 minutes or more.

Code 99378 covers the same areas as 99375, but for a hospice patient.

New HCPCS Codes

Medicare, under the impression that the new CPT language would include communication with non-health- care professionals, began implementing the G codes in response to this intended revision. In clarifying its reasoning, HCFA explained in its Final Rule published in the Nov. 1, 2000, Federal Register that although the CPT Committee had not released its final definition, the revised codes make a significant change.

Specifically, the new definitions include the time the physician spends communicating with nonprofessional caretakers involved in delivering the home health or hospice services. While HCFA recognizes that nonhealth professionals contribute to the care of both home health and hospice patients, its long-standing policy has been that payment for these services is [...]