Pulmonology Coding Alert

Question: We had a patient visit our pulmonology practice for a consultation. The patient presented symptoms of wheezing, shortness of breath during physical activities, a chronic cough, and fatigue. The physician documented the patient’s history, performed a physical exam, and spent 60 minutes with the patient and their spouse discussing what tests will be performed to help diagnose the patient’s condition.

I understand Medicare and some payers don’t accept consult codes, but this patient’s payer does accept them. Which consultation code do I need to assign for this visit?

Ohio Subscriber

Answer: For this visit, you’ll assign 99244 (Office consultation for a new or established patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.).

Each evaluation and management (E/M) code requires the provider to fulfill certain components during the visit to ensure reimbursement. With 99244, those components include:

• A comprehensive history;
• A comprehensive examination;
• Medical decision making (MDM) of moderate complexity
• 60 minutes of time

In your question, you mentioned the physician examined the patient, went over their medical history, and spent one hour speaking with the patient and their family.

Symbols: As with the other outpatient E/M service codes, 99244 features a star symbol that indicates you may report the code for telemed visits. Based on CPT^® guidelines, this means if your provider performed the E/M visit via video chat then you could still assign 99244 for the encounter and append modifier 95 (Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System), assuming your provider offered the service using both audio and video technology. Note that payers may have different rules regarding which codes to report for telemed services and which modifiers or place of service codes to use, so be sure to check individual payer guidelines.