Reimbursement for Home Visits

Vol. 16 •Issue 7 • Page 14
Coding Connection Q & A

Reimbursement for Home Visits

Q: Has Medicare decided to reimburse for respiratory therapy visits in the home under any circumstances?

A: There are no changes currently to the rules regarding RT services. I haven’t seen the topic discussed in quite some time. There are home visit codes for home respiratory therapy (99503) and home mechanical ventilation care (99504), but there’s no payment to RTs due to the lack of being able to get an NPI number as a provider.


Q:If we use automatic resuscitators in the ER on our patients, which CPT codes would we use? Are we able to bill for this device?

A:The use of automatic resuscitators isn’t billable separately; they have no separate codes. If there were a code request, it would be to the CPT Editorial Panel or CMS for a HCPCS code. CPT doesn’t appear to have such a request from a manufacturer for a code that I can find. The only HCPCS code is for percussive ventilation supplies and accessories.


Q:Will Medicare pay for a PPD (CPT code 86580) done in our pulmonology practice, or should we just bill a 99221 with screening diagnosis code (V-code)? We tried to bill Medicare using 86580 with a diagnosis code for TB screening (V-code), and they denied the claim, stating they don’t pay for screening.

A:Medicare does pay for the 86580 code with one of several diagnosis codes: 795.5 — nonspecific reaction to tuberculin skin test without active tuberculosis abnormal result of Mantoux test; PPD positive; tuberculin (skin test): positive, reactor; V01.1 contact with or exposure to tuberculosis and conditions classifiable to 010-018 — as well as many symptom codes related to the respiratory system.

If the patient isn’t symptomatic, then your Medicare carrier is correct. It’s a screening service and not payable unless the patient has signed an ABN.


Q:Is there a CPT code for respiratory therapy consult or assessment and treatment recommendation?

A:Currently there are no CPT codes for a respiratory therapy consult or assessment. Respiratory therapist services aren’t reimbursable under the current payment scheme by payers.


Q:What code should be used for obtaining mucous samples from the nasopharynx by catheter? Catheter aspiration comes up as 31720, but that’s going into the lungs. Our respiratory department needs a code for collecting these specimens obtained for RSV testing.

A:There’s an HCPCS code — D0416 for viral culture. I don’t see a fee attached to the code, but some payers might accept it for your purposes.


Q:I need a CPT code (initial and subsequent) for noninvasive ventilation for neonates.

A:The neonatal critical care codes include any form of ventilation. These codes are for physician services only. The per diem fee paid to hospitals by insurers includes the RT’s services and aren’t payable separately.


Q: What’s the CPT code for impulse oscillometry?

A: Impulse oscillometry (IOS) is a device for asthma patients that measures respiratory impedance (respiratory resistance and reactance) by having the participant breathe normally into a mouthpiece for a short period while various frequencies are superimposed at the mouth, as reported in Annals of Allergy, Asthma, & Immunology earlier this year. Spirometry is the gold standard for measuring airway obstruction in asthma patients. But it requires a forced breathing maneuver, which isn’t easy to do, the researchers wrote.

“IOS can not replace spirometry, as some asthmatics have normal values for IOS but have lower spirometry results,” they concluded. “However, IOS may play a complementary role in the diagnosis of airway obstruction and bronchodilation in asthmatic adults.”

Because it’s a comparatively new procedure, there’s currently no specific CPT code to report the study. After contacting several payers, they said they would most likely deny claims with the “unspecified” CPT code for pulmonary services 94799 because there isn’t enough literature available to prove validity of the test.

Ray Cathey, PA-C,FAAPA, MHA, FAHC, CHCC, is the president/owner of Medical Management Dimensions, LLC in Stockton, Calif.