Vol. 17 •Issue 3 • Page 12
Coding Connection Q & A
Nebulizer Treatment Supplies
Q:Getting reimbursed for nebulizer treatments is problematic. The 94640 code isn’t inclusive with all of the supplies such as mouthpieces, tubing sets, etc. Is there a bundled code that includes these items?
A: Unfortunately, there is no bundled code that covers all of the supplies used in nebulizer treatments. Mouthpieces and tubing sets aren’t payable separately in the medical office. The equipment, including disposables, are required items for the procedure and therefore are included in the payment for the treatment. The non-medication supply codes in the A700X area of the Healthcare Common Procedure Coding System (HCPCS) code set are for use only by durable medical equipment and home health suppliers.
CPR MANAGEMENT
Q: Can we charge for cardiopulmonary resuscitation when chest compressions aren’t done, but CPR meds are given? Do CPR drugs (i.e. atropine, epinephrine) qualify as CPR by themselves?
A: Code 99050 requires management of a patient in cardiac and/or respiratory arrest. Giving atropine or epinephrine to prevent a patient from “coding” without all of the other elements of the CPR management wouldn’t qualify.
REPEAT ENDOTRACHEAL SUCTIONING
Q: If a respiratory therapist performs endotrachael suctioning (no nebulizer treatment is involved) two or three times during one patient visit, can each suction be charged, or should this be considered one treatment?
A: The suctioning is counted as one session/treatment no matter how many times the RT suctions the airways.
NEBULIZER MODIFIERS
Q: Currently we bill 94640 for the first nebulizer treatment prescribed each day. For all subsequent nebulizer treatments of the day, we use 94640 with modifier -76.
Other hospitals use 94640 for the first nebulizer treatment of the admission, and then for all subsequent nebulizer treatments of that admission, they use 94640 with modifier -76. Which is correct?
A: Either billing mechanism is correct. The nebulizer treatment code 94640 is considered a once-daily code. It’s appropriate to bill with “-76” to identify more than one treatment in a given day. Some institutions add the “-76” to all subsequent treatments to prevent payers from considering a treatment without a modifier to be duplicate billing.
Medicare Reimbursement for Simple Spirometry
Q: What is the Medicare reimbursement rate for just the technical portion of the a simple spirometry and pre and post?
A: 94010 is a simple spirometry. The Arkansas 2007 Medicare fee schedule for 94010-TC (technical component) is $20.51. It lists reimbursement for CPT Code 94060-TC — bronchodilation responsiveness, pre- and post-bronchodilation administration, as $33.77.
Check the 2008 fee schedule once Congress completes its fee schedule fix to eliminate the 10.1 percent across-the-board cut.
E/M AND CPAP OR VENT
Q: Will Medicare pay for E/M (99232) and continuous positive airway pressure (94660) or ventilation (94003) done on the same day? If so, what modifiers are needed?
A: Medicare won’t pay for an E/M code and ventilator management (94002-94003) on the same date. The CPAP code that you refer to (94660) is only for initiation and management of CPAP for obstructive sleep apnea in the office setting.
BUNDLED PULSE OXIMETRY
Q: Why won’t Medicare pay for 94760? We have many patients that have pulse oximetry and an office visit in the same day. Please advise.
A: Medicare bundles the reimbursement for pulse oximetry (94760) into any procedure and/or visit. Medicare pays separately for 94760 if it’s the only procedure provided. This means that if you bill any other code on that day, you can’t bill pulse oximetry as well. Medicare considers pulse oximetry to be a technical-only charge.
CMS ruled in 1999 that pulse oximetry is no more difficult than taking the patient’s temperature and should be reflected as such. The physician billing is accounted for by including the interpretation as part of the E/M code. Charging a higher level of service because pulse oximetry is performed would be inappropriate.
Various commercial payers have followed Medicare’s lead. A few carriers, however, don’t bundle pulse oximetry with other codes, so you can bill for it separately in those cases.
Ray Cathey, PA-C, MHA, FAHC, CHCC, is the president/owner of Medical Management Dimensions in Stockton, Calif.