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Pulmonology Coding Alert

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G Codes Offer Smooth Transition to CMS Final Rule

Published on Wed Sep 22, 2010

Support your PR program with diagnosis of moderate to severe COPD.The passing of CMS' final rule for national coverage of pulmonary rehabilitation (PR) services, effective beginning  an. 1, doesn't mean you're trouble-free when coding for your pulmonologist's outpatient PR program or expanded in-office PR services.But don't worry. You can pick up some essential PR coding and coverage insights from these 3 common situations.1. Pulmonologist Doesn't Provide Direct PR Care The pulmonologist may not be directly involved, but you won't be short of coding options. CMS guidelines require a comprehensive pulmonary rehabilitation program to be physician-supervised. It includes physician-prescribed exercise, education or training, psychosocial assessment, outcomes assessment, and an individualized treatment plan. Pulmonologists may bill E/M codes for periodic visits to evaluate the patient's underlying condition, any exacerbations, and response to therapy. For example, report follow-ups with an E/M code, such as 99214 (Office or other outpatient visitfor the evaluation and [...]
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