Pulmonology Coding Alert

You'll see higher payments as a result

If your pulmonologist provides consultations, take note of the CPT deletions of follow-up and confirmatory consultation codes that go into effect on Jan. 1. The good news about these changes is that you may actually see $10 to $12 more on each in-patient follow-up visit. CPT 2006 Also Clarifies Modifier 25 When the CPT updates take effect, pulmonologists will face two major E/M changes. CPT 2006 will:

• delete follow-up inpatient consultations (99261-99263, Follow-up inpatient consultation for an established patient ...) and confirmatory consultations (99271-99275, Confirmatory consultation for a new or established patient ...)

• clarify the explanatory text for modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to specify that documentation must support the significant and separate E/M claim. What You Report Instead Remember that you will begin reporting all follow-up inpatient care with subsequent hospital care codes 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient ...), but the deletions don't change the way you report the physician's initial inpatient consults. You will continue to bill those as 99251-99255 (Initial inpatient consultation for a new or established patient ...).

The elimination of the follow-up inpatient consultation codes will make coding of inpatient visits easier for physicians. "These codes were rarely used correctly and so put physicians at a good deal of risk when they were used," says Marcella Bucknam, CPC, CCS, CPC-H, CCS-P, HIM program coordinator at Clarkson College in Omaha, Neb. And carriers rarely reimbursed appropriately and many insurers did not reimburse at all for follow-up consultations, Bucknam adds.

How it works: When your pulmonologist receives a request for a consult in the inpatient setting, you may claim an initial inpatient consult (99251-99255) for the visit. If your physician sees the same patient during the same inpatient stay, you should report subsequent hospital care codes (99231-99233), not follow-up inpatient consult codes (99261-99263) as you would have in 2005.

Example: Another physician asks your pulmonologist to see a newly hospitalized patient with chronic obstructive bronchitis and a new right lower lobe (RLL) infiltrate accompanied by fever, cough and yellow sputum. Your physician diagnoses pneumonia and starts the patient on antibiotics. Four days later, the attending physician asks that the pulmonologist see the patient again to outline a home-treatment program before discharge.
 
You should charge an appropriate level of consult for the first visit (99251-99255) and a subsequent hospital care code (99231-99233) for the second visit.
 
Use ICD-9 codes 486 (Pneumonia, organism unspecified) for the pneumonia if your physician didn't identify an organism, and use 491.20 (Obstructive chronic bronchitis, without exacerbation), 491.21 (Obstructive chronic bronchitis, with [acute] exacerbation) or 491.22 [...]