Pulmonology Coding Alert

Question: Can we bill code 90846 for our pulmonologist when she is meeting with family (in the hospital or office) without the patient to discuss treatment, care and questions regarding the patient?

Georgia Subscriber

Answer: CPT^® code 90846 (Family psychotherapy [without the patient present]) is specific to psychiatric services and is inappropriate in the situation you presented.

Family meetings to discuss treatment options for the patient are best reported with counseling time, especially more than 50 percent of the encounter was spent counseling/coordinating patient care. If the patient is unable to participate in the discussion, there must be a statement as to this reason. The reason must be a medical reason representing a cognitive inability (rather than the patient being unavailable for the discussion), and this is typically more acceptable for an inpatient scenario.

Discussions are not merely providing updates to the family, but require decision making or instruction on the implementation of the care strategies. As an inpatient, this discussion must take place at bedside or on the patient’s unit/floor.

Visit selection is based on the total encounter time (inpatient: face-to-face plus unit/floor time; outpatient: face-to-face time only). You should add a notation that > 50 percent of 35 minutes was spent counseling. This scenario can also be identified as a specific amount of time: 25 of 35 minutes. The details of the counseling must be documented (e.g., increased oxygen requirements for severe COPD exacerbation with impending ventilation considerations, energy conservation techniques, medication compliance).

For an inpatient, your best choice equates to 99233 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity…), as this would likely be provided during follow-up. Be sure that reporting services without the patient present is accepted by your payers.