Problem:

I was asked to see a 17 year old male because he was applying to a military academy. The health letter written by his Pediatrician identified an episode of acute bronchitis two years prior to his application. The academy requested a pulmonary consultation and pre- and post-bronchodilator spirometry before further consideration of the application.

The “patient” had no complaints related to his respiratory system. The past medical history revealed only a single episode of acute bronchitis that did not require hospitalization and recovery was complete. There was nothing of concern in the Family History, Social History,or Review
of Systems. The examination was normal. The pre-and postbronchodilator spirometry was normal with no obstruction and no bronchodilator responsiveness.

What is the appropriate E&M code and what diagnosis should I list?

Will his commercial insurance carrier pay for this or will the military academy? Will the parents be forced to pay for it?

What's your answer? Please see below for Dr. Jacobson's answer and discussion.

Answer:
The corerct CPT code for this vignette is 99243 - mid-level outpatient consultations.

Discussion:

The correct CPT code in this vignette is 99243 mid-level outpatient consultations. The teaching point here is that a consultation can be requested by not only physicians but by school personnel, P.T., speech pathologist, or school psychologist. Outpatient office visit codes are 99211-99215. If a patient makes the referral, or an insurance company requests a second opinion, as delineated in CPT-4, then one uses the confirmatory consultation CPT codes (99271-99275). To meet the requirement of the code it is necessary that communication back to the requesting physician or other appropriate source as a written report. Although you can use a confirmatory code in this vignette I look at this as not a 2nd opinion but a specialist opinion. You can now see that coding is somewhat of an art. The reimbursement for the 99240 series is higher than the 99270. I agree using 94060 for spirometry. Reimbursement may or may not be paid by the commercial carrier. I doubt that the military academy would
pay. Here is where it is important for someone to discuss this with the patient when he comes in as he may end up paying the charges.