Pulmonology Coding Alert

These 3 scenarios will help improve your E/M skills.Before you report any E/M procedures, look for documentation details on the patient's presenting illness because this information can make or break your patient's complete history documentation.Check out the following three frequently asked questions to determine your review-of-systems (ROS) savvy, then determine your coding tactics before reading the correct answers below.Be Careful of Communication ChallengesQuestion 1: A new patient who is unable to speak English and fully explain her medical problems presents to your pulmonologist. The patient's inability to communicate and lack of a translator prevents your physician from obtaining a complete history of present illness (HPI) and ROS. Your pulmonologist treats the patient but cannot develop a definite plan for her treatment.After the visit, the pulmonologist calls the patient's previous physician to discuss her medical problems and discovers that she also has diabetes and asthma. Including face-to-face patient time (45 minutes) and telephone calls to other providers (45 minutes), your physician spends a total of 90 minutes on this patient during the same day.How should you charge for this scenario? Which E/M codes and modifiers should you use to justify the extra time your physician spent on the phone?Answer 1: You should select the appropriate level of E/M service (99201-99205, Office or other outpatient visit for the evaluation and management of a new patient ...) based on the information your physician obtained from the patient and her previous physician.Time it: If you want to bill based on time, the pulmonologist must spend more than 50 percent of the total face-to-face time counseling and/or coordinating care with the patient. If your physician's encounter does not meet this requirement, you cannot bill based on time.Warning: In most cases, you cannot bill based on time if the pulmonologist states that a communication barrier extended the face-to-face time with the patient because the time did not involve counseling or coordination of care. The pulmonologist may document the excessive effort of trying to get an appropriate history with the reason for excessive effort and a reason for why he was unable to obtain the full history. He may receive "comprehensive" credit for the "unattainable" history.If your physician documents service time when the patient is not physically present (such as the post-exam call to the other physician), you cannot report this time to most payers, says Heather Corcoran, coding manager at CGH Billing in Louisville, Ky.Most payers consider both telephone calls and charting time part of the pre- and post-service work already included in payment for the E/M service. If you submit a charge for this extra time to a payer that does not cover the service, the carrier might hold the patient responsible for the fee.Verify [...]