Pulmonology Coding Alert

Question: A family practitioner sent a patient to my pulmonologist with a mass on the chest x-ray and asked him to determine the correct course of treatment for the patient. The pulmonologist performed a thorough examination before deciding to perform a transbronchial lung biopsy on the patient. Can I bill a separate E/M service, or just the transbronchial lung biopsy?

New York Subscriber

Answer: If the pulmonologist documents a significant, separately identifiable E/M service, you can report an E/M code (for example, 99205, Office or other outpatient visit for the evaluation and management of a new patient ...). You should 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 the E/M code to distinguish the E/M service as significantly above that included with the biopsy. For the lung biopsy, don't forget to report the bronchoscopy with transbronchial lung biopsy (31628). Report 786.6 for the lung mass and any other diagnoses confirmed during the evaluation.

Read the notes: The documentation should reflect a significant, separately identifiable E/M service. You are looking for a history, examination, and medical decision making (MDM) separate from a procedure note for the transbronchial lung biopsy. To justify billing this E/M service separately, you should find the management decisions, which include the bronchoscopy, in the E/M's MDM.