Pulmonology Coding Alert

Question: Our critical access hospital would like to set up a pulmonary rehab program. What code should I use for the initial pulmonary rehab interview or consult?

Texas Subscriber

Answer: CPT contains no specific codes for pulmonary rehab. If a pulmonologist performs an initial evaluation that meets the requirements of a consultation, use the appropriate inpatient consultation code (99251-99255, Inpatient consultation for a new or established patient ...). Otherwise, report hospital care (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ...).

Medicare had proposed to cover pulmonary rehabilitation for chronic obstructive pulmonary disease (COPD) patients as a Part B service in the hospital and office settings. Proposed decision memo CAG-00356N set forth a definition of pulmonary rehab and described its components. CMS solicited comments on the frequency and duration of respiratory therapy services, as well as comments on the proposed determination. In July 2007, CMS decided against covering pulmonary rehab because Medicare law does not list the service as a benefit.

Both houses of Congress have a bill concerning pulmonary rehabilitation services. If passed, the legislation would allow national coverage of those services.