Pulmonology Coding Alert

Question: My pulmonologist frequently provides care in the nursing home setting -- am I correct in sticking to 99307-99310 to report these encounters? Also, should I be hesitant to report 99310 for a physician who is not the attending of record in the nursing facility?

New Jersey Subscriber

Answer: Consider whether the visit qualifies as a consultation before reporting one of the subsequent nursing facility care codes (99307-99310).

If the visit meets consultation requirements, report an inpatient consultation code (99251-99255) for the first visit, use the subsequent nursing facility care codes for any further medically necessary visits.

If the visit does not meet consult requirements, you may report subsequent-day care with 99307-99310 from the first encounter.

The key to deciding which level code to report is the extent of the service and documentation and whether the level is supported by medical necessity.

Example: The pulmonologist visits a nursing facility patient on oxygen who suffers from chronic obstructive bronchitis and emphysema. He spends time with the patient and her family members to discuss next steps and possible treatments. This counseling, and the subsequent coordination of the patient's wishes, takes 36 minutes, which is also the total duration of the visit.

Using time as the controlling factor, you can report this encounter with 99310 (Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: a comprehensive interval history; a comprehensive examination; medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Physicians typically spend 35 minutes with the patient and/or family or caregiver).

Don't forget to attach 491.20 (Obstructive chronic bronchitis; without exacerbation) to document the patient's treatment.

Tip: When you file this claim, make sure to document the total visit time, a summary of topics discussed, and a description indicating that more than half of the total visit time involved counseling and coordination.

You do not always have to document time to justify the E/M. Use time as a basis for visit level selection when more than 50 percent of the physician's total visit time is spent counseling/coordinating care.

If these time guidelines are not met, select the visit level upon the documented key components (history, exam, decision making).