Pulmonology Coding Alert

Question: A cardiologist sent a patient with COPD to our pulmonologist for a preoperative clearance consultation prior to heart surgery. Our physician cleared the patient for surgery. How should we report this? I'm leaning toward reporting 99245 for the E/M service, but a coworker says we should use 99242 or 99243.

South Carolina Subscriber

Answer: You should select the E/M level based on the documentation that the pulmonologist recorded for the medically necessary service the physician provided. If documented correctly, you can report a high-level E/M, such as 99244 or 99245 (Office consultation for a new or established patient) for the preoperative clearance consultation.
 
To document a high-level E/M, the physician must complete a comprehensive history, which includes a chief complaint, four elements of the history of present illness, 10 systems reviewed, past history, family history, and social history; a comprehensive exam, using either 1995's guidelines that require one comment in eight systems, or 1997's guidelines that call for two comments in nine systems; and high- complexity medical decision-making.
 
Your physician should develop a treatment plan for the patient that establishes recommendations for pre- and postoperative care.
 
The pulmonologist may decide that the patient has a high risk factor for major elective surgery if the physician finds that the COPD will threaten the patient's life during surgery.
 
For the pulmonologist to complete the consultation requirements, he or she should provide the recommendations for care to the requesting physician.
 
Most physicians send the requesting physician a letter detailing the recommendations. Your physician should document the service as a consultation.
 
Also, the physician should list the patient's underlying pulmonary conditions as emphysema (492.8) in addition to the preoperative respiratory examination code (V72.82).