Vol. 15 •Issue 9 • Page 12
Coding Connection Q & A
Repositioning an Endotracheal Tube
Q: If an endotracheal tube is initially inserted and positioned on an emergency basis (CPT code 31500) and then later repositioned (two hours later) for improvement, can you bill and be paid for two units on this code?
A: Medicare cautions physicians to use this code in emergency or crisis situations, not for elective intubation. Your documentation should support an emergent need through appropriate ICD-9 codes. You also may want to submit a procedure note to support the emergent nature of the procedure.
CPT 31500 is exempt from modifier -51, so you don’t need to use a “multiple procedures” indication when billing it with other procedures.
If the patient is accidentally extubated and is still in need of the endotracheal tube, I would suggest using modifier -76 (repeat procedure, same physician) or modifier -77 (repeat procedure, different physician). There’s no additional billing for repositioning a previously placed endotracheal tube.
CODE FOR TRANSPORTING INPATIENTS
Q: We’re doing increasingly more ventilator transports for special procedures. These transports are very time consuming and use supplies and equipment. Is there any code for charging for these transports? I haven’t been able to locate one.
A: Unfortunately, no code exists for transporting inpatients for special procedures.
ATTENDANCE AT HIGH-RISK DELIVERIES
Q: Can a department charge for attendance at a high-risk delivery or c-section?
A: While there are physician neonatal critical care codes, there’s currently no mechanism that I’m aware of to report department staff attendance to these procedures. I’ve researched the ICD-9 volume 3 procedure codes and couldn’t locate appropriate coding.
BILLING FOR THORACENTESIS
Q: With thoracentesis billing, is it the same if we do diagnostic tap with small needle as therapeutic tap with thoracentesis kit and much bigger needle (should I use 32000 and 32002 together)?
A: CPT suggests by its description that the 32000 thoracentesis code is for diagnostic purposes. Needle/catheter size isn’t addressed.
The 32002 code suggests by its example, pneumothorax, that it should be used in that instance or in other moderate volume thoracentesis. It would be inappropriate to bill the two codes together.
CHARGING FOR NEB TREATMENTS; COVERING SMOKING CESSATION
Q: I work in a pulmonologist’s office and was told that you can’t charge for nebulizer treatment or instruction along with an office visit. Is this true?
Secondly, with the G0375 and G0376 codes, I understand, as a respiratory therapist, I can do this brief counseling session at the same time of a patient’s office visit. We have other office staff members who are medical assistants. Can they also provide counseling to the patient in my absence, the same way I would be covered in the “incident to” clause?
A: To answer your first question, nebulizer treatments should be billed separately from E/M or other procedures with CPT code 94640.
If an E/M code is done at the same time, the E/M code is modified with -25. If more than one nebulizer treatment is done on the same date, bill multiple units in the appropriate box on your CMS 1500.
For your second question, the qualifying factor for the smoking cessation codes for Medicare patients is that it’s done by appropriately trained staff under the supervision of a physician.
If your medical assistants receive proper training, they should be qualified to assist in this teaching.
CARDIOPULMONARY RESUSCITATION AND RESPIRATORY ARREST
Q: Can we charge CPT 92950 (cardiopulmonary resuscitation) for someone in respiratory arrest?
A: CPT 92950 is only for the physician component of the service. If your facility has in-house (paid) intensivists or hospitalists who run codes, then this could be used.
Otherwise, the appropriate ICD-9 procedure code is the mechanism for payment for this service:
- 99.60 (cardiopulmonary resuscitation NOS),
- 99.61 (atrial cardioversion)
- 99.62 (heart countershock NEC)
- 99.63 (closed chest cardiac massage)
- 99.64 (carotid sinus stimulation) or
- 99.69 (cardiac rhythm conversion NEC).Ray Cathey, PA-C, MHA, FAHC, CHCC, is the president/owner of Medical Management Dimensions in Stockton, Calif.
