Pulmonology Coding Alert

Question:

Washington, D.C. Subscriber

You can only bill a separate E/M on the same day as a procedure when a separately identifiable issue is managed. Counseling the patient's family issues does not constitute medical management, neither does reviewing the post-procedural care instructions.

Also, keep in mind that a cursory history and physical (i.e., brief history including medication reconciliation and brief exam) is a must on procedure day to collect the necessary pre-procedural information and confirm the patient's ability to undergo the procedure. Management of a separate issue requires additional work beyond the scope of the procedure (e.g., review of management options for IDL-interstitial lung disease -- newly confirmed through bronchoscopy).

CPT says: "You can bill a H&P outside of the global surgical package, but it remains to be seen whether individual insurance companies will interpret the new guideline in this manner, or not pay for any pre-operative H&P. The physician should still be performing the service in a time frame that is in the best interest of the patient from a clinical perspective. This may mean that the H&P is done a week before surgery."