Vol. 16 •Issue 1 • Page 12
Coding Connection Q & A
Charging for Incentive Spirometry
Q: Can we charge for incentive spirometry instruction using 94664? If not, is there any code we can use for one-time instruction? We are an acute care hospital.
A: 94664 is demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler, or IPPB device. Incentive spirometers don’t fit into the category of these types of devices.
Additionally, respiratory care isn’t covered as a separately billable service for recipients in a nursing facility level A or B, a subacute care facility, or inpatient locations because the care is administered by facility personnel using facility equipment.
Reimbursement is included in the per diem rate paid to a long-term care facility or in the institutional revenue codes of hospitals.
SVN Medication Charges
Q: Normal nebulizer meds are included in the charge of a small volume nebulizer treatment — but what about meds like Decadron, Mucomyst, Atropine, etc., that are added to treatments occasionally? Am I wrong to charge for these extra meds because we’re delivering them via SVN?
A: SVN treatments include the bronchodilator medication when charging for the inpatient treatment with these devices. It’s appropriate to charge for “atypical” drugs when they’re ordered as additional medications.
CPAP Interpretation Code
Q: What code should be used when a physician does the interpretation of a two-week home continuous positive airway pressure auto-titration study when he’s not the physician who prescribed the CPAP? He’s only doing the interpretation and giving recommendation to the ordering physician.
A: The appropriate code to use in this instance is 94660 (CPAP initiation and management). I would be certain that the prescribing physician isn’t also using this code because your practice is actually doing the interpretation and management.
Nurses Performing Treatments
Q: We have nurses who do respiratory treatments, and I would like to know if we can get reimbursed from Medicare for the procedures they do. Also, with the demo/eval code, do you have to use a modifier on it if the patient is admitted after being seen in the emergency room?
A: Whether the individual is a respiratory therapist or a nurse, there’s no additional coding for the services in the inpatient setting.
The demo/eval code (94664) is for use in the clinic/outpatient setting only.
Flow-volume Loop or Spirometry?
Q: Can one legitimately bill for interpreting the flow-volume loop (94375-26) rather than spirometry (94010-26)? The one is just the graphic display of the other, but Medicare reimbursement is somewhat larger for the flow-volume loop than for spirometry.
Also, can one legitimately bill for interpretation of plethysmography (93722)? There’s not a specific value assigned to “plethysmography” in the PFT report (as compared to TGV or airflow resistance), and so no interpretation actually can be made. My understanding is that 93720 refers to plethysmography used for vascular rather than respiratory assessment. However, our PFT lab does bill for the technical component (93721).
A: To answer your first question, I find a significant number of practices across the country bill 94375 (flow-volume loop) instead of 94010 (spirometry). While common, there’s always the question of “correct coding.”
My advice is to bill the service that you order/perform, regardless of higher payment. Compliance guidelines mandate that we do so.
For the second question, many payers, including Medicare, Aetna, and others do pay 93720 — total body plethysmography (or its component codes) — for lung evaluations. They haven’t restricted its use to vascular evaluations only.
While listed in CPT under the “Other Vascular Studies” heading, that doesn’t imply only vascular specific evaluations. As you’re aware, a lot of information may be obtained from a “body box” evaluation.
Aetna considers total body plethysmography medically necessary for any of these indications:
1.for measurement of lung volumes to distinguish between restrictive and obstructive processes
2.for evaluation of obstructive lung diseases, such as bullous emphysema and cystic fibrosis, which may produce artifactually low results if measured by helium dilution or nitrogen washout
3.for measurement of lung volumes when multiple repeated trials are required, or when the subject is unable to perform multi-breath tests
4.for evaluation of resistance to airflow
5.for determination of bronchial hyperreactivity in response to methacholine, histamine, or isocapnic hyperventilation.
Ray Cathey, PA-C, MHA, FAHC, CHCC, is the president/owner of Medical Management Dimensions in Stockton, Calif.