Pulmonology Coding Alert

Your pulmonologist usually provides pre-, post-op consults.Coders who don't want their consult claims cancelled should take a second and check out these expert opinions on when to code a consult -- and when to choose another reporting option."A consultation is basically a request for opinion or advice, because the requestor does not have expert knowledge in that area," explains Denae Merrill, CPC-E/M, owner of Merrill Medical Management in Michigan.But it can be a bear sticking to all of the consult reporting rules, because your coding will vary based on location and service level. Read on for more information on coding -- and documenting -- your consultations correctly each time.Consult Patients Return to Requesting PhysicianIf a physician is treating a patient and needs to ask for your pulmonologist's input on treating that patient for a certain condition, you should consider it a consultation. When she provides the consultation in an office setting, you select one code from 99241-99245 (Office consultation for a new or established patient ...). Your code choice depends on the elements of history, examination, and medical decision making that your physician documents during the visit.Some guidelines require a physician or qualified nonphysician practitioner (NPP) to make the request for a consult, but others state that the request can be from a physician or other appropriate source. You must also be wary of state scope of practice issues before your NPP files a request for consultation. Remember: Medicare limits the request for consultation to "qualified" NPPs who are capable of implementing the treatment plan the consultant suggests. Therefore, the most qualified NPPs may be limited to a nurse practitioner, physician assistant, clinical nurse specialist, or certified nurse midwife.Watch for Comorbid Condition ConsultsSome of your pulmonologist's consultations will be for patients undergoing surgery, either before or after the procedure. The patient most likely will have a chronic medical condition that may affect or be affected by the perioperative course; and the consult is designed to answer the question: "Can this patient go through with the surgery and survive afterwards?"See "Know When to Code for Pre-Op Consult" on page 84 for examples of how to answer this question.Pre-Op Service May Be Office E/M, Not ConsultThe most common pre-op inpatient consult occurs when a patient presents to the ED and the surgeon admits the patient for surgery, but the patient has a comorbid condition that requires surgical clearance or risk assessment (as in the examples on page 84). In these cases, the surgeon requests a consult for the pulmonolo-gist's opinion regarding the patient's stability for surgery.When your pulmonologist performs this inpatient consultation, report the most appropriate choice from 99251-99255 (Inpatient consultation for a new or established patient ...), depending on the level [...]