Pulmonology Coding Alert

Question: Can we bill based on time if we see two patients during the same visit? I spent 50 minutes in a room counseling a parent who brought in her two kids, both of whom are chronic asthmatics. One of the sisters also had bronchitis and the other had sinusitis. We talked for 30 minutes about appropriate use of the nebulizer preemptively because the parent had never used it. We also talked about getting the children appropriate winter gear so they wouldn’t be breathing in cold air when they walked to the bus stop, and other issues related to their asthma. The counseling took up about 15 minutes for each child.

Florida Subscriber

Answer: You can bill for this visit based on time if more than 50 percent of the time you dedicated to one child was spent counseling about that child’s condition/care, but you should create two separate encounters for the siblings and count only the time spent for each patient. For example, if you spent 25 minutes with each and counseled each for 15 minutes, you’d bill 99214 (Office or other outpatient visit for the evaluation and management of an established patient…) for each patient and write the documentation separately, including how much total time was spent, how much time was spent counseling, and what was discussed for each patient in their visit encounter.