Service Level Ties Allergists, Pulmonologists to Codes

Allergies and asthma often go hand-in-hand, so a patient suffering from both conditions may need to see more than one specialist. With the allergy season in full swing, now is a good time for allergy and pulmonology practices to familiarize themselves with Medicare policy to ensure concurrent care reimbursement.

Medicare reimbursement for concurrent care is tied directly to the level of service. Both physicians must provide services more extensive than consultations and both must play an active role in the patient’s ongoing care.

You must also be able to justify having two related specialties on board, says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.

To ensure payment for concurrent care:

  1. Verify that the diagnosis or diagnoses support the medical necessity; and,
  2. Clarify the care both doctors provided.

To make your case:

  • Highlight exacerbations as key to diagnosis criteria; and
  • Ensure specialty services stand out.

Read the complete story, “Concurrent Care Coding Tips: Pulmonologist & Allergist,” posted June 5 by Coding News.

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