EM Coding Alert

Question: During an E/M service, our provider ordered oxygen therapy for a 65-yeear-old patient with a history of intrinsic non-allergic asthma. Can we report oxygen therapy separately from the E/M service?

Florida Subscriber

Answer: CPT^® considers oxygen therapy part of the E/M, so you cannot code the therapy separately. You should, however, roll the work units for the oxygen therapy into the overall E/M service level. So let’s say that for the entirety of the visit, the physician performed a problem-focused history, a detailed exam and moderately complex medical decision-making.

On the claim, you would report 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity) for the E/M with J45.901 (Unspecified asthma with [acute] exacerbation) appended to represent the patient’s asthma.

Also: Depending on the length of the encounter, you might include prolonged services codes (+99354, +99355) to bill for the extra time. You can bill for prolonged services only when there is direct (face-to-face) provider/patient contact. For example, assume the 99214 visit lasts 55 minutes, including the oxygen therapy.

In this instance, you might be able to report +99354 (Prolonged evaluation and management or psychotherapy service[s] [beyond the typical service time of the primary procedure] in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour [List separately in addition to code for office or other outpatient evaluation and management service]) in addition to 99214.

Remember: If you do report a prolonged services code, include J45.901 to prove medical necessity for the prolonged service, along with a note explaining that the oxygen therapy is what extended the encounter.

Caveat: The +99354 and +99355 codes are new for 2016, so payers might not be used to seeing them. You might want to contact the payer to see how, or if, you should use the new prolonged services codes. For example, the payer might want additional documentation with claims involving these new codes.