Pulmonology Coding Alert

Question: An established patient with acute pulmonary edema reports to the pulmonologist for a checkup. Based on the checkup, the pulmonologist decides that the patient needs nursing facility care. Later that day, the pulmonologist goes to the nursing facility to oversee the patient's admission. Can I report a code for each visit?

Nevada Subscriber

Answer: You can report only one code in this scenario. Check out this info from the introductory section for "Initial Nursing Facility Care" in CPT 2008:

"When the patient is admitted to the nursing facility in the course of an encounter in another site of service (e.g., hospital emergency department, physician's office), all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial nursing facility care when performed on the same date as the admission or readmission."

In a nutshell: All E/M services provided on the same day as a nursing facility (NF) admission are considered part of the initial NF care.

So you won't be able to report the office visit with 99211-99215 (Office or other outpatient visit ...). But be sure to report the NF code based on level of service. So if your physician's notes indicate a level-two initial NF service, report 99305 (Initial nursing facility care, per day, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision-making of moderate complexity).

Also, append 518.4 (Acute edema of lung, unspecified) to 99305 to document the patient's pulmonary edema.

Note: The only physician permitted to "oversee" the admission and report initial nursing facility care is the physician who certifies the admission, writes the orders, and assumes responsibility for complete care of the patient. If your physician is not assuming this role, you should report subsequent nursing facility care (99307-99310) for any medically necessary service provided to a nursing facility patient.

If the patient's attending physician seeks your pulmonologist's opinion/advice, select a code from the most appropriate inpatient consultation codes (99251-99255) -- as long as the visit fulfills all of the consult requirements.