Pulmonology Coding Alert

A pulmonologist who bills inpatient hospital visits as concurrent care should emphasize the condition he or she is treating, which may not be the same reason the patient was admitted to the hospital. Concurrent care occurs when two or more physicians treat the same patient on the same day. The patient's condition must warrant the services of more than one physician on an attending basis, which means the patient will probably have different diagnoses that require treatment by physicians of different specialties. For example, a pulmonary physician admits a diabetic patient to the hospital for pneumonia (486). The patient's diabetes (250.0x) has been exacerbated by the pneumonia. The pulmonologist treats the patient's pneumonia, while an internist or endocrinologist treats the diabetes. Because the pulmonologist admitted the patient to the hospital, he or she would report one of the initial hospital care codes (99221-99223). Both physicians would be able to bill subsequent hospital care codes (99231-99233) to cover the continuing evaluation and management of the patient. Neither doctor would need to append a modifier (e.g., -25, Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the hospital care codes to report the concurrent care visits unless the physicians are part of the same group billing under the same tax identification number. Primary Diagnosis Is Condition Being Treated The key to being consistently reimbursed for concurrent care is to stress the different conditions (diagnoses) being treated. Pulmonologists should link their services to the condition they are personally treating. In the example above where the pulmonologist and the internist are providing concurrent care, the pulmonary physician should list pneumonia (486) as the primary diagnosis code, says Teresa Thompson, CPC, a pulmonology coding and reimbursement specialist in Sequim, Wash. "Even though the diabetes is considered in the pulmonologist's medical decision-making, he or she should not list the code."

Meanwhile, the internist should list diabetes as the primary diagnosis on his or her claim. "This will support the medical necessity of both physicians attending the patient on the same day," Thompson says. Toni Revel, CPC, a coding expert and nurse practitioner based in Warrington, Pa., agrees: "Both physicians reporting the same diagnosis, even as a secondary diagnosis, can lead to a claim rejection, especially in this case when they are similar specialties, i.e., both branches of internal medicine."

Pulmonologists must also be able to document that their services were medically necessary. Stopping by the patient's room to see how he or she is doing or for a social visit does not constitute concurrent care. The same components of all E/M visits history, examination and medical decision-making or counseling/coordination of care time must [...]