Pulmonology Coding Alert

Question: Can a patient be billed twice on the same day? The nurse practitioner in our practice evaluated a patient for cough, palpitations and fatigue, did EKGs and x-rays, and spent a lot of time talking to the family. Two hours later, the pulmonologist saw the patient and repeated the history and exam, subsequently admitting her to the hospital. Can we bill for the office visit the nurse practitioner did earlier in the day?

Nebraska Subscriber

Answer: Assuming the nurse practitioner and pulmonologist are in the same practice, and that no new symptoms appeared suddenly before the pulmonologist examined the patient, all the evaluation and management (E/M) service should be rolled into the hospital admission code (99221, initial hospital care, per day, for the evaluation and management of a patient which requires medical decision making of low complexity, physician spending 30 minutes at the bedside; 99222, initial hospital care requiring medical decision making of moderate complexity, physician spending 50 minutes; or 99223, initial hospital care, high complexity, 70 minutes).

You can bill for any electrocardiograms (EKGs) (93000, electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) and x-rays (for example, 71010, radiologic examination, chest; single view, frontal) done in your office.

Both of these services are billable if performed in your office. Documentation should include a separate, signed, written report of findings to support the billing for the professional component of these services.

Answered by Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C.