Pulmonology Coding Alert

Question: Our pulmonologist spends about 10-15 minutes for asthma education for some patients. Can we bill these services under 98960-98962 or any other appropriate code?

Minnesota Subscriber

Answer: No, you cannot bill these services under 98960 (Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient [could include caregiver/family] each 30 minutes; individual patient), 98961 (Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient [could include caregiver/family] each 30 minutes; 2-4 patients) or 98962 (Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient [could include caregiver/family] each 30 minutes; 5-8 patients) since these codes comprise a structured educational curriculum provided by a nonphysician.

Non-physician health care professionals will include a nurse practitioner or a physician assistant and may extend to a qualified respiratory therapist or nurse who has received appropriate training in asthma education. But, it is best to check with your state laws and individual payers to see who will qualify.

The instructions being provided should be in accordance with an established curriculum that has been recognized by an organization or a professional society. Per CPT®, the purpose of the educational and training services is to teach the patient (may include caregiver[s]) how to effectively self-manage the patient's illness(s)/disease(s) or delay disease comorbidity(s) in conjunction with the patient's professional healthcare team.

Education provided by physicians to an individual patient must be reported with standard E/M codes. When reporting an E/M using 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient...), the asthma education becomes part of the E/M code and cannot be billed separately. However, if your pulmonologist spend more than half of the time on providing the asthma education, you can report a higher E/M code that will cover the total face-to-face visit time inclusive of the time spent for the education.