Pulmonology Coding Alert

Pulmonologists usually assume care, negating a consult--but there are exceptions

For E/M services that start in one location and end in another, getting the payment your pulmonologist is ethically due hinges on reporting the correct code.

For instance, using an initial inpatient code when the visit counts as a consult could cost the pulmonologist $40 per encounter--reporting 99222 (3.40 nonfacility relative value units) instead of 99254 (4.46 nonfacility RVUs) results in a loss of $40.17 using the 2007 National Medicare Physician Fee Schedule. But this coding when the reverse is true could trigger refund requests.

See if your claims would withstand an audit by testing your hand with the following scenarios, then read our experts' answers. Use 1 Code When In-Office Becomes Admit When coding for office visits and admission services, you should report only one E/M service per calendar day, says Mary Mulholland, MHA, RN, CPC, senior coding and education specialist for the department of medicine at the Hospital of the University of Pennsylvania.

Example: A pulmonologist diagnoses a patient with pulmonary embolic disease (such as 415.19, Pulmonary embolism and infarction; other) during an in-office visit and then admits the patient to the hospital. Inpatient records show the pulmonologist saw the inpatient the same day as the office visit.

Do this: You should report only the initial hospital care with 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient ...), says Rhonda Buckholtz, CPC, practice administrator at Wolf Creek Medical Associates in Grove City, Pa. But "you can use the documentation from both visits to report your level of service," she adds. For instance, if the pulmonologist makes a quick note on the office visit and then starts the inpatient note for the admission, you would combine the documentation to select the appropriate level of initial hospital care code.

Important reminder: To report the initial hospital service (99221-99223), the physician must provide a face-to-face encounter in the hospital setting.
 
"Having only a face-to-face encounter in the office does not allow the physician to report the initial hospital visit," says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia. In these cases, the pulmonologist should instead report an office visit (99201-99215, Office or other outpatient visit ...). Separately Code for Admit on Day 2 Don't assume that every time an office visit results in a hospital admission that you'll bill only one E/M service. When a pulmonologist admits a patient to the hospital from the office, he may not necessarily see the patient on the same day, Mulholland says. The attending physician may see the patient and complete the admission service the next day.

Because the attending has 24 [...]