Pulmonology Coding Alert

Question: Can we bill for oxygen therapy given to patients in the office during an E/M service?

Mississippi Subscriber

Answer: As oxygen therapy during office visits by patients is part of the E/M service, you cannot bill the therapy separately. There is also no CPT® code specified for oxygen therapy administered in the office. In these instances, you should only bill the appropriate E/M code (99201-99215).

Also, you should include prolonged services codes (99354-99355) to bill for the extra time where this is applicable. These prolonged services codes, however, can be billed only when there is direct (face-to-face) patient contact by the billing provider lasting at least 30 minutes beyond the time associated with the primary E/M code. For example, assume the E/M service is a midlevel service for an established patient that lasts 50 minutes, including the oxygen therapy; you would code this as 99213 plus +99354 (requiring a total visit time of 45 minutes):

• 99213 -- Office or other outpatient visit for the evaluation and management of an established patient ... Physicians typically spend 15 minutes face-to-face with the patient and/or family
• +99354 -- Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service; first hour (List separately in addition to code for office or other outpatient Evaluation and Management service).