Pulmonology Coding Alert

Question: The doctor sees a patient for chronic obstructive pulmonary disease (COPD) exacerbated by cough and difficult breathing. A chest x-ray is taken, a comparison is made, and the patient is given a nebulizer treatment. The doctor spends a total of 45 minutes with the patient. Should we code for counseling and co-ordination of care for 45 minutes? How should we code this?

Loretta Del Rio
Bend, OR

Answer: Using a code based on counseling and coordination of care would be appropriate only if the physician documented that the majority of his time with the patient was spent as such. This does not seem to be the scenario you described.

Based on your information, this scenario would be billed 99213 (office or other outpatient visit for the evaluation and management of an established patient ... ) or 99354 (prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service ... ).

In other words, begin by billing the appropriate evaluation and management (E/M) code, according to documentation guidelines, then code additionally for the time exceeding the E/M code. Codes 99354-99357 are used for prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service ...

These codes are considered add-on codes and must be listed in addition to a primary procedure. They do not need a modifier.

Prolonged service is reported in addition to the E/M service at any level. The time spent must be more than 30 minutes beyond the normal service. Service of less than 30 minutes is included in the E/M code.