Pulmonology Coding Alert

Question: A 78-year-old established Medicare patient suffering from chronic obstructive pulmonary disease (COPD) and asthma is admitted to the hospital as an inpatient for acute exacerbation. The next day, a fully licensed nonphysician practitioner (NPP) performs an expanded problem-focused history and an expanded problem-focused exam to check the patient's condition.About four hours later, the pulmonologist meets with the patient, evaluates the patient's pulmonary function tests and performs a brief pulmonary exam. Is this a shared visit?

Answer: This E/M may qualify for shared/split visit billing, but you must satisfy Medicare's specific documentation guidelines for the claim.

Report the following codes:

• 99232 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components:an expanded problem focused interval history; an expanded problem focused examination; medical decision making of moderate complexity ...) for the E/M

• 493.22 (Chronic obstructive asthma; with [acute] exacerbation) appended to 99232 to represent the patient's COPD.

The notes need to show specific details about both encounters, and include specific physician input on the patient. When reporting a shared visit, be sure to include a) documentation of the combined notes written by the pulmonologist and the NPP that support the E/M level, b) a statement clearly identifying the NPP and pulmonologist providing the service, c) a link between the pulmonologist's documentation and the NPP's, d) the pulmonologist's documentation of a face-to-face encounter, and e) legible signatures from the pulmonologist and NPP providing the E/M.

When you report a shared visit, Medicare allows you to report with the pulmonologist's national provider identifier (NPI), garnering the practice 100 percent pay for 99232. If you bill the same visit under the NPP's NPI, you'll get 15 percent less for the same service.

Lastly, keep in mind that shared/split billing only applies to E/M services provided by nurse practitioners, physician assistants, clinical nurse specialists, and certified nurse midwives in the emergency department, outpatient hospital, and inpatient hospital.

-- Answers to You Be the Coder and Reader Questions were reviewed by Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta; and Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.