Pulmonology Coding Alert

Question: Our physician spent two hours with a patient on asthma education. How should we code this?

Florida Subscriber

Answer: If the physician has documented that more than 50 percent of the two-hour session with the patient was spent on counseling and coordinating care, report 99215 (office or other outpatient visit) for the E/M of an established patient, because the doctor spent at least 40-minutes with the patient providing counseling/coordination of care services. Also, report 99354 (prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service [e.g., prolonged care and treatment of an acute asthmatic patient in an outpatient setting]; first hour [list separately in addition to code for office or other outpatient evaluation and management service]).

Finally, 99355 (... each additional 30 minutes [List separately in addition to code for prolonged physician service]) should also be billed because it represents the remainder of time. Codes 99354 and 99355 are add-on codes and cannot be reported without an E/M.

Note: Often, insurers will not pay for 99354, a headache that doctors may be able to avoid by requesting their carrier to include in the contract, patient counseling and education services.