Pulmonology Coding Alert

Question: Is there a CPT code for providing asthma education to a patient?

Virginia Subscriber

Answer: You can report S9441 (Asthma education, nonphysician provider, per session) for asthma education by a nonphysician practitioner. For Medicare beneficiaries, there are several reporting options that involve counseling/ coordination of care (C/CC).

To report C/CC, the provider must spend more than 50 percent of the total face-to-face visit time counseling the patient and/or coordinating care. You should then select the level of service based on the documented time.

For example, if the total visit time for an established outpatient is 25 minutes, and the provider spent 15 of the 25 minutes counseling/coordinating care, the provider may report 99214 (Office of other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three components: a detailed history, a detailed examination, medical decision making of moderate complexity). You should have adequate documentation of C/CC time and total visit time.

Reporting time for inpatient services involves face-to-face and unit/floor time. If a physician in your practice completes the asthma education, you can report the appropriate E/M level of service on the date the physician provided the teaching.

If the nurse performs the asthma education, you should bill 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services), provided that the physician is in the office suite during the time the nurse renders the service (otherwise, you should not report a service to Medicare).

If a nurse practitioner or a physician assistant provides the asthma education, you can bill for the appropriate E/M patient visit code under his own provider number, unless guidelines for reporting the service under the physician's name are met.