Pulmonology Coding Alert

Question: A surgeon in our physician group performed a lung transplant on a female patient. Eighteen days after the procedure, the patient developed an infection at the site of the incision. Our pulmonologist visited the patient at her home, where he examined and cleaned the infection. The pulmonologist then changed the wound dressings and gave the patient some antibiotics. Can we report a separate evaluation and management (E/M) for the at-home visit, or is it part of the global surgical package?


Kentucky Subscriber
Answer: You may be able to garner separate E/M payment with some private payers, but Medicare is another story.

With private payers, there is the option of reporting an E/M service in this scenario--perhaps 99348 (Home visit for the evaluation and management of an established patient, which requires at least two of these three key components:  an expanded problem focused interval history; an expanded problem focused examination; medical decision making of low complexity) would be appropriate.
 
If you choose to report 99348 for the service, you might want to consider attaching modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the code, depending on the individual carrier's guidelines for services included in the global package. The modifier indicates that the service is not included in the global fee for the initial surgery.

Don't forget: To attach V42.6 (Lung transplant) in addition to the code for the infection to 99348 to show the patient recently had a lung transplant.

For a Medicare payer, however, the visit is considered part of the global package for a lung transplant, so you cannot report 99348 for the pulmonologist's follow-up service if he is in the same physician group as the surgeon. If the pulmonologist is in a separate group (i.e., reports claims under a separate tax ID number), the pulmonologist is not bound by the surgeon's global period, and can report 99348 without need of a modifier.