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Pulmonology Coding Alert

You Be the Coder:

Know Your Limits on Prostacyclin Challenges

Published on Mon Nov 14, 2005

Question: My pulmonologist wants to bill for a prostacyclin challenge test. He performed the procedure at the hospital. Is there a way I can report the professional component of this service?


New Mexico Subscriber


Answer: CPT has no code to describe physician supervision of a prostacyclin challenge test. This is because the IV infusion itself requires physician administration or supervision. Because a nurse typically provides the service under the physician's supervision, you cannot separately bill a professional component for this service in the inpatient setting.

Another option: While you can't consider cardiac output measurements part of the supervision for IV infusions, your physician may incorporate the cardiac output readings into the data component of his medical decision-making. This potentially increases the level of complexity you can report for the encounter.

Caution: CPT suggests another option involving prolonged services. It can take a pulmonologist several hours to supervise this test, so you may consider reporting a prolonged inpatient service code for this reason (99356-99357). Prolonged service codes require the physician to be present (face-to-face) with the patient during the time reported, but the physician's presence does not have to be continuous. The time is cumulative for one calendar day, and your pulmonologist must document his time in the medical record.

Note, however, that the insurance plans that do pay for prolonged services don't pay very well and the reimbursement may not appropriately reflect the time involved with this test.

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