Pulmonology Coding Alert

Answer: You need to ask a few more questions before you can get to the appropriate codes. The first question to ask is: Who performed the service?

If a nurse administered the oxygen and took the vital signs and the physician was merely present in the office, the service would be billed as 99211 (office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually the presenting problem(s) are minimal...). This code lists 5 minutes as a typical amount of time performing the service.

If the physician was involved in the exam and/or the treatment, using 99212 (office or other outpatient visit for the evaluation and management of an established patient...) would be appropriate if the documentation demonstrated an appropriate level of the key components (problem-focused history and examination and straightforward medical decision-making) or if the face-to-face time (for counseling/coordination of care) is documented as 10 minutes.

Use 99213 (office or other outpatient visit for the evaluation and management of an established patient...[expanded problem focused history and examination/low complexity decision making]) if the key components match those listed or if the time spent by the physician face to face with the patient is documented as 15 minutes.

The next question to ask is: How critical was the patients condition? CPT 2000 states: a critical illness or injury acutely impairs one or more vital organ systems such that the patients survival is jeopardized. If this were the case, then it would be possible to bill a critical care code, such as 99291 (critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes), if 30 minutes or more were spent in constant attendance (not necessarily at bedside) by the physician to treat the critically ill patient.

CPT 2000 also states: Time spent in activities that occur outside the unit or of the floor ... may not be reported as critical care since the physician is not immediately available to the patient, So it is important, if billing critical-care codes, that the patient was receiving the doctors full attention. If the patient could not speak, as is frequently the case with patients presenting with severe shortness of breath and the doctor needed to obtain a medical history from a family member, this time can be billed with critical care coding, provided that the conversation bears directly on the medical decision-making.

Anything less than 30 minutes will require the appropriate evaluation and management E/M code. Than 74 minutes can be coded with an add-on 99292 for each additional 30 minutes.

Cynthia Thompson, CPC, senior consultant at Gates, Moore & Co, a physician-practice management-consulting firm in Atlanta, provided advice that helped answer You Be the Coder.