Vol. 15 •Issue 1 • Page 12
Coding Connection Q & A
Pulse oximetry considered a vital sign
Q: What’s Medicare’s policy for reimbursement on oximetry? Is it different if the patient is being billed for aerosol treatments at the same time?
A: Since 2001, it has been Centers for Medicare & Medicaid Services’ national policy not to allow for payment of pulse oximetry as a separate payment with any evaluation and management (E/M) code. It’s essentially considered a vital sign.
Aerosol or nebulizer treatments can be billed on the same date as an E/M service, but the E/M code must be appended with a -25 modifier and a different diagnosis than the treatment.
Instructional Time Up to Payer Discretion
Q: Is it allowable to charge CPT 94664 (“demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device”) on a daily basis, or is it a one-time instructional thing? The descriptor says “may be charged one per day.”
A: The 94664 descriptor does state “one per day.” We’ve never been successful in getting payers to reimburse for it more than one time per week or so. It’s purely payer discretion.
Document Need for Oxygen
Q: We currently charge for oxygen three times per day (day, evening and night, totaling 24 hours). This is very time consuming for the staff to have to go do oxygen rounds, then have to charge each patient three times per day. Can oxygen be charged once every 24 hours instead?
A: In order to charge, the shift respiratory therapist must round and document the continued need for oxygen.
Actigraphy a Category III CPT Code
Q: I would like to know what billing codes to use for actigraphy for private insurances. Typically the device is initiated, the patient then wears it for a specific time, the information is then downloaded, a report is generated, and the data are reviewed by a physician.
A: There’s a Category III CPT code for actigraphy: 0089T actigraphy testing, recording, analysis and interpretation (minimum of three-day recording). Category III CPT codes aren’t assigned a relative value unit for reimbursement. Practically speaking, this means that the while the code is recognized, it won’t be reimbursed by Medicare until a Category I code is generated.
Many private payers do recognize CPT Category III codes within about six months of their release. You’ll need to check with individual payers to review their policy.
Pulmonary Function Testing Requires Timely Interpretation
Q: Does a pulmonary function test need to have a physician interpretation in order to be reimbursed by Medicare?
A: Just as long as you’re billing your services using the TC modifier, the interpretation doesn’t have to be complete at the time of your billing.
Joint Commission on Accreditation of Healthcare Organizations guidelines require that physician interpretation be done in a timely manner. It’s left up to the hospital to interpret that statement, but generally it’s interpreted to mean within 48 to 72 hours.
Use Correct Code for Outpatient Six-minute Walk Test
Q: We currently use CPT code 94761 (multiple oximetry) for charging inpatients and outpatients for a six-minute walk test while qualifying them for home oxygen. Is this the correct code to use?
A: 94761 is correct for the hospital but not the office/outpatient setting. The proper code is 94620.
When to Use a Modifier for Exercise Pulmonary Function Testing
Q: We’re having trouble billing for a spirometry test (94010) in conjunction with a complex exercise pulmonary function test (94621). We routinely perform a baseline spirometry on these patients to determine baseline level, but our CCI edits are telling us we can’t bill them together. Can we use modifier -59 with the 94010, or can this be billed at all together?
A: You’re correct: CCI 11.3 bundles the 94010 into the 94621. The only appropriate time to use modifier -59 is if you had a distinctly different diagnosis for doing a 94010 (different session, different reason) on the same date.
For example, a doctor ordered a spirometry this morning for dyspnea and later in the day ordered a complex pulmonary stress test on the patient for clearance for a lung reduction surgery (or other procedure).
Ray Cathey, PA-C, MHA, FAHC, CHCC, is the president/owner of Medical Management Dimensions in Stockton, Calif.
