Pulmonology Coding Alert

Question: The pulmonologist in our multispecialty practice performed an E/M service on a patient who has shortness of breath. A few months before, the family practitioner treated the patient for an unrelated condition. Which E/M code should we use and why?

Mississippi Subscriber

Answer: You should base the appropriate code for the pulmonologist's E/M service on several factors. CPT describes a new patient as someone a physician or other medical staff hasn't seen in three years. If the family practitioner belongs to the same group practice as the pulmonologist, and reports his or her services under the same tax identification number, you can consider the pulmonologist and family practitioner part of the same group. In that case, bill an established patient code (99211-99215). When physicians report claims under different tax ID numbers, even though they belong to the same practice, insurers don't consider the physician part of the same group. Therefore, you should report a new patient visit code (99201-99205).