Pulmonology Coding Alert

Question: Our physician went to the nursing home to see a Medicare patient for consultation. After the examination, she also performed pleural drainage. How should I code the visit and the service? If we do not meet all three requirements to charge a new patient visit. Would I use 99307? 

Illinois Subscriber

Answer: If the visit was for a new patient, you can use the codes for initial nursing home care 99304-99306 (Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components:…)

However, these codes require that the three key components — history, physical examination, and medical decision making — be fulfilled. If any of the three components are not documented properly, you will not be able to bill these codes. For the pleural drainage, you should report 32556 (Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance).

Medicare defines the initial visit as the initial comprehensive assessment visit during which the physician completes a thorough assessment, develops a plan of care and writes or verifies admitting orders for the nursing facility resident. For Survey and Certification requirements, a visit must occur no later than 30 days after admission. This only applies to the admitting physician of record who will report 99304-99306 with modifier AI to distinguish them from anyone else. Since pulmonologists are not the admitting provider, they report the initial nursing facility care without modifier AI.

If the conditions are not met, then you can use 99307-99310 (Subsequent nursing facility care per day, for the evaluation and management of a patient...).