Pulmonology Coding Alert

Question: A new patient who resides in an assisted living facility was treated for emphysema, hypertension, and new onset cough by the visiting physician. Can we still report this with 99339 or 99340?

Michigan Subscriber

Answer: The domiciliary or rest home service done by the physician in this example is an E/M service and should not be confused with codes for care plan oversight (CPO) of a patient in a home, domiciliary, or rest home, which includes an assisted living facility (99339-99340). Instead, use E/M service codes for newpatient domiciliary, rest home, or custodial care services (99324-99328), depending on the level of the service.

In your example, suppose the physician visited the new patient in the assisted living facility and was able to assess the patient's medical condition from a detailed history and detailed examination and proceeded to treat and manage the patient using moderate medical decision making. It would be appropriate to report this as 99326 (Domiciliary or rest home visit for the evaluation and management of a new patient ...).

If the physician provides a higher level of service than the above example, then use the other applicable new-patient codes for this category from 99325-99328.

Beware: Medicare and other insurers typically do not recognize codes 99339-99340. They consider these services "bundled" and not separately payable to any provider.