Pulmonology Coding Alert

Question: We recently had this type of claim. Hospital Consultation/ (High Complexity), Critical Care First Hr., over 60 mins. Thepulmonologist also performed Bronchoscopy (with BAL), and Insert Emergency Airway. All on the same day. How should I code this situation?

Answer: A little more additional information is required to answer this query perfectly. We need to know whether both the inpatient consultation and the critical care (CC) service were provided by same or different physician, with same or different tax id no. (same or different specialty and group practice), and which service came first in the day. Here we are assuming that the patient is not a pediatric case (age is more than 71 months).

For the high complexity consult, you can report 99255 (Inpatient consultation for a new or established patient, which requires these 3 key components…). For the CC, you should be looking at 99291 (Critical care, evaluation and managementof the critically ill or critically injured patient; first 30-74 minutes) You can only bill both the high complex consult andthe CC service on the same day if the first service of the day was the consult, and the patient did not require critical care at that time. Here we are assuming that the two visits were on different times of the same day.

Code 99291 cannot be billed more than once on a single day. Using the code +99292 will depend upon the total time of CC service provided on a single day (each 99292 code for every additional 30 min after the first 30-74 min). In the example, since we do not know the exact amount of critical care time “over 60 minutes”, only report 99291. You will have to appendmodifier 25 to 99255.

 You can separately bill for code 31624 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage) for the bronchoscopy and 31500 (Intubation, endotracheal, emergency procedure) also for an adult patient.

As there are no restrictions for billing theseservices on the same day, you can bill 99291, 31624, and 31500 safely. It is strongly suggested that the visit note include a statement that the critical care time does not include any of the separately billable procedural time to prevent any misunderstanding by the payer. Please remember, as cautioned earlier, 31500 cannot be used as a separate code when the patient is 29 days through 71 months of age. In that case, the code 31500 is included within the CC service provided.