Pulmonology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: A primary-care physician (PCP) called our pulmonologist for consulting services for an inpatient one evening. He spoke with the PCP on the phone and spent a lot of time researching a particular diagnosis and possible treatments but did not actually see the patient until the next day to scope the patient. How should we report the pulmonologist's work? Massachusetts Subscriber

Answer: The most widely recommended option for coding your scenario is to apply the time spent on the telephone call when deciding the appropriate level of E/M service for the patient's next visit. Phone consultations, especially with other physicians, can boost the level of medical decision-making for that next visit. If you choose to apply the time to the medical decision-making, be sure your pulmonologist properly documents the phone conversation in the office note of the next visit. You could try using the CPT telephone call codes (99371-99373). These codes report "telephone calls by a physician to patient or for consultation or medical management ... with other health care professionals (e.g., nurses, therapists, social workers, nutritionists, physicians, pharmacists)."

If you use telephone-call codes, however, you could run into a major problem. The Medicare Carriers Manual explicitly states that CMS will not pay for telephone calls because payment is included in other billable services, such as the visit or surgery. Insurance companies do not like to pay for these codes because they assume they are used to represent time spent talking to patients. But many coders still recommend coding for these calls to track and report all services provided. If your practice assigns any fee to these codes, the patient will be responsible to pay any services not covered by the insurer, says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.

Most physicians therefore choose not to report these codes if they know they are bundled services or they think their patients will be responsible for the payment.

If you do report these codes, and carriers deny these claims, call the provider representative and explain that the calls were spent discussing the case with another physician, not the patient. Try to negotiate with your payer to cover payment for telephone calls as part of your contract with that payer.

You could use prolonged service codes but only to represent time spent on telephone calls more than 30 minutes long when the call occurs on the same day as the visit or procedure. For example, a pulmonologist performs a consultation with a patient complaining of respiratory problems. That [...]