Pulmonology Coding Alert

Question: How can we get paid for an office consult (99244) and a thoracentesis (32000) on the same day? When we submit these codes, our carrier rejects them.

Washington, D.C., Subscriber

Answer: You can report procedures such as a thoracentesis on the same day as an office visit. Because 32000 is a starred procedure, CPT includes only the surgical aspect in this code. In other words, CPT doesn't include any preprocedure or post-procedure services, such as an office consult (99244, ... for new or established patient ...) in the code. For example, your pulmonologist evaluates a patient's underlying condition, such as shortness of breath (786.05), prior to performing the thoracentesis to remove and examine the fluid causing the patient's symptoms.

When you report the office consultation on the same day as the procedure, append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99244.

Also, you should list separate ICD-9 codes with each service to justify separately reporting each service. For instance, you could report 99244 with shortness of breath (786.05), and submit 32000 with 511.9 (Pleural effusion).

Even so, non-Medicare insurers will not pay for more than one service, stating that any procedures your physician performs include an E/M service. If a private carrier is rejecting this claim, you could look into renegotiating your contract so the insurer will approve the claim in the future. Otherwise, you have to abide by the company's policies.