Pulmonology Coding Alert

Question: A pulmonologist in our practice completed an inpatient consultation, an initial vent management service and a bronchoscopy on the same day. Can we bill for all of these procedures?


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Answer: You may not bill an inpatient consultation code (99251-99255) along with an initial vent  management code if the pulmonologist performed both procedures on the same day. You should only report the inpatient consultation code.
 
Bonus: You can append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) if the pulmonologist performed the bronchoscopy as a result of the consult.

If the documentation supports that the pulmonologist provided the evaluation and the vent management as critical care services, you could bill a critical care code (99291-99296) with modifier -25 appended, along with the bronchoscopy code, as long as your pulmonologist's documentation supports the time and the work involved in the delivery of the critical care services. You should not report the vent management, because it's a component of the critical care services.

On the other hand, if the pulmonologist performs the procedures on different days, you can bill a consultation code (99251-99255) without modifier -25. 

In addition, if provided on a different day, you can bill the initial vent management with 94656 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; first day) on a subsequent day.

Don't miss: If provided on the same day, you should append modifier-25 to the ventilation management code, if the pulmonologist performed the bronchoscopy on the same day.

You should report the most appropriate bronchoscopy code in this scenario (31622-31656). For example, if the pulmonologist documents performing a diagnostic bronchoscopy with cell washings, you should report 31622 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]).

Remember: CPT defines a critical illness or injury as one that impairs one or more vital organ systems, creating a high probability of imminent or life-threatening deterioration in the patient's condition.

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