Pulmonology Coding Alert

Answer: 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, it 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 for the service.

If the physician were involved in the exam and/or the treatment, 99212 (office or other outpatient visit for the evaluation and management of an established patient ...) would be appropriate. You should make sure 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 with the patient is documented as 15 minutes.

The next question to ask is: How critical was the patients condition? A critical illness or injury acutely impairs one or more vital organ systems so that the patients survival is jeopardized. If this were the case, then it is 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.

CPT 2001 states: Time spent in activities that occur outside the unit or the floor ... may not be reported as critical care since the physician is not immediately available to the patient. Therefore, if billing these codes, it is important to note if the patient was receiving the doctors full attention. If the patient could not speak, as is frequently the case when 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 more than 74 minutes can be coded
as 99291 with 99292 (...each additional 30 minutes [list separately in addition to code for primary service]). Code 99292 is an add-on code and cannot be reported alone.