Vol. 16 •Issue 9 • Page 14
Coding Connection Q & A
Reimbursement for Separate Visits
Q: Is it common practice to schedule a patient for two separate visits to address pulmonary and sleep issues with each counting as a new visit/consult? Are there any insurance reimbursement problems?
A: In virtually all situations, the physician who requested the original consultation wants you to evaluate and initiate treatment for all problems found. You only can bill for the consultation on the first visit.
It would be a rare situation to evaluate only one condition at a time. It would be even more unusual that a pulmonary/sleep physician would charge a separate consultation for evaluation for each condition, if both conditions were identified at the time of the initial consultation. Further evaluation services are billed as established patient office visits.
Interpretation of Six-minute Walk
Q: Does a six-minute walk test have to be interpreted by a physician to get reimbursement from Medicare?
A: Yes, a physician interpretation is required for Medicare reimbursement.
Billing for Spirometry
Q: For spirometry with pre- and post-bronchodilation, we currently bill for the inhaler and spacer separately, and they’re billed under revenue codes as non-covered pharmacy charges. Is this appropriate? In the CPT manual under 94060, it states, “Report bronchodilator supply separately with 99070 or appropriate supply code.” I work in a regional medical center.
A: If you were office-based, only the actual bronchodilator could be billed. In your current setting, other supplies may be charged as you currently do.
Denied Payment for 94664
Q: Some payors/insurers will deny payment for CPT code 94664 (demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler, or IPPB device) when used with an evaluation and management service such as 99204.
I’ve heard it’s better just to bill the E/M code with a modifier, like 99204-25 or even 99204-59. What’s best?
A: Many payors will deny the 94664 code on the day of an E/M visit. However, most will pay for the service if you append the -25 modifier to the visit code. If the payor still won’t accept the 94664, it will be necessary to bring in the patient at a separate visit just for MDI/inhaler training in order to receive payment.
Billing 94660 With G0237 and G0238
Q: Can code 94660 be billed with G0237 and G0238 and more than twice a year?
A: These are pulmonary rehab codes and usually are covered by Medicare in that setting. There’s an excellent article in CHEST (www.chestjournal.org/cgi/content/full/129/1/169) that covers the issue well.
Using 31625 and 31628
Q: Are CPT codes 31625 and 31628 allowed to be billed in the same encounter?
A: 31628 and 31625 are billable at the same bronchoscopy encounter if modifier -59 is used on each of them, according to the current CCI edits.
CONSCIOUS SEDATION UPDATE
Q: As a pulmonologist performing a bronchoscopy, can I bill separately for conscious sedation (i.e., 99144, in an endoscopy suite)? Both conscious sedation and bronchoscopy would be performed by me.
A: There’s good news here. Medicare announced in a policy revision on Aug. 27, 2007, that it will now start paying for conscious sedation, effective Oct. 1, 2007. The entire policy can be accessed via www.cms.hhs.gov/MLNMattersArticles/downloads/MM5618.pdf.
FREQUENCY OF 94770
Q: We’re using noninvasive CO2 monitoring (both expired gas analysis and transcutaneous methods) on a daily basis. Sometimes only a spot check is needed. Sometimes monitoring is needed during or immediately after the procedure, but it’s also fairly common to monitor for days at a time.
We’re using code 94770 but have been unable to get definitive answers regarding the frequency and specificity of how to use it.
A: The vast majority of payors won’t permit separate payment for a physician interpreting laboratory testing — that service is bundled into the physician E/M services billed for hospital inpatients.
The hospital should be reimbursed according to the payment policies for hospital inpatients, depending on contracting issues, per diem, DRG, etc.
It’s a common practice for expired gas CO2 monitoring to be used daily on post-surgical/post-trauma patients. There’s no CPT code currently for transcutaneous monitoring.
Ray Cathey, PA-C, MHA, FAHC, CHCC, is the president/owner of Medical Management Dimensions in Stockton, Calif.
