Pulmonology Coding Alert

Question: A patient underwent a lung transplant two weeks ago. Yesterday, the pulmonologist had to meet the patient at the hospital to treat a wound abscess around the surgical area. Notes indicate that a level-two evaluation and management service was performed. The patient did not return to the operating room. Can we report this service, or is it bundled into the lung transplant?


Oregon Subscriber

Answer: Though she does not perform the lung transplant, the pulmonologist often works with the surgeon to provide postsurgical care to transplant patients. As long as the surgeon and the pulmonologist are in different physician groups, you may be able to report the E/M. However, the rules for reporting this encounter differ among different payers.

Option 1: When reporting to some carriers, you may be able to code for a hospital admission code. On the claim, you could:

• report 99222 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these three key components: a comprehensive history, a comprehensive examination, and medical decision-making of moderate complexity) for the postsurgical care.

• append ICD-9 codes 996.84 (Complications of transplanted organ; lung) and V42.6 (Organ or tissue replaced by transplant; lung) to 99222 to prove medical necessity for the procedure.

Not all payers allow coding for follow-up visits during the global period. Call your insurer before filing a 99222 claim.

Medicare: In this scenario, you can report the E/M to Medicare if you are a pulmonologist and not the surgeon who performed the transplant. According to the Centers for Medicare & Medicaid Services, you cannot charge for the readmission when complications arise during the global period of the original surgery. Since pulmonologists typically are not part of the surgeons' provider group, pulmonologists are not bound by the surgeons' global period.