Pulmonology Coding Alert

Question: A pulmonologist reviews lab test results and orders additional testing and medication changes for skilled nursing facility patients. Can the pulmonologist charge for this if the patient was not seen by the pulmonologist or the nursing staff didn't see the patient face-to-face?

Connecticut Subscriber

Answer: No. CPT 99211 (Office or other outpatient visit for the E/M of an established patient, that may not require the presence of a physician; usually the presenting problem[s] are minimal; typically, 5 minutes are spent performing or supervising these services) requires direct contact between your office's incident-to employee and the patient.

In this case, no direct service occurred between the patient and the pulmonologist/nurse, particularly if the nurse discussed the reaction over the phone with the patient's caregiver.

Good news: Your pulmonologist may not be giving away reviews/medical changes for free. E/M services include some related post-work time, so reviewing lab results might be included in the related nursing facility visit (such as 99307-99310, Subsequent nursing facility care per day, for the evaluation and management of a patient, ...) in which the pulmonologist ordered the tests.