 |
 |
 |
| ACCP Practice Management Educational Resources |
| ACCP Educational Resources for the ABIM Asthma Practice Improvement Module |
| PCCU Online! |
| Pulmonary Artery Catheter Education Program |
Coding and Documentation Questions and Answers from Live Practice Management WebinarsPhysician’s Current Procedural Terminology (CPT) codes, descriptions, and numeric modifiers are copyright 2007 by the American Medical Association. All Rights Reserved. Disclaimer Q & A's From Most Recent Webinar-Dec 10, 2008 PQRI Update 2009 Q & A's From Webinar-Nov 19, 2008 Coding and Documentation Update 2009 Albuterol/Levalbuterol HCPCS “J” Codes | Anticoagulation Management | Arterial Blood Gas | Bronchoscopy | Central Line Placement Documentation | Chemical Pleuodesis | Consultation Codes | Critical Care | Endobronchial Ultrasound for Bronchoscopy (EBUS) | Evaluation and Management Services | ICD-9-CM Diagnosis Codes | Injections | IV Infusion of Alpha-1 Replacement Therapy | Methacholine Challenge | Omalizumab Injection | Pleurolysis | Pulmonary Diagnosis Codes | Pulmonary Function Tests (PFTs) | Pulmonary Rehabilitation | Pulse Oximetry | Nebulizer Treatment Code | Smoking Cessation Counseling | Thoracentesis | Ultrasound Guidance With Lungs and Pleura | Ventilator Management | Miscellaneous
Audience Questions Q: When do the doctors get their Physician Quality Reporting Initiative (PQRI) money in 2009? Do we have to file anything? A: Eligible professionals (EPs) who satisfactorily report quality measures data for services furnished January 1, 2009, through December 31, 2009, will earn a single consolidated incentive payment in mid-2010. The incentive payment will be 2.0% of estimated total allowed charges for covered Medicare Part B Physician Fee Schedule services provided January 1, 2009, through December 31, 2009. Incentive payments will be paid to the taxpayer identification number (TIN) under which the incentive-earning professional submitted PQRI claims. See the PQRI Web site (www.cms.hhs.gov/pqri), Analysis/Payment section. EPs who qualify for the incentive do not need to file any paperwork to receive the earned incentive. The incentive payment will be sent by the carrier to the entity holding the TIN. Information about how to access 2009 PQRI Feedback Reports will be posted on the Centers for Medicare and Medicaid Services (CMS) Web site by mid-year. Q: eRx performance: I noticed that Rx refills are excluded. Please explain. A: Please review the eRx measure specifications. A designated encounter, such as an office visit, is required to report this measure. Any prescription that results from that encounter may be reported per the measure instructions if the EP has a working qualified e-Rx system. Q: I am currently unable to e-prescribe to mail order pharmacies. How does that change my reporting? A: Please review the measure specifications. There is a code that may be reported for circumstances when a pharmacy cannot accept an e-prescription transmittal. Q: Measure 53: Am I to report for Medicaid as well? A: No. PQRI applies only to Part B Medicare FFS (fee-for-service)-covered services under the Physician Fee Schedule. Q: Do Medicare Advantage plans support PQRI? A: Please see PQRI FAQ #9543: Can eligible professionals (physicians and nonphysicians) get paid a PQRI incentive payment and a separate e-prescribing incentive payment for charges submitted for care rendered to Medicare Advantage (MA) patients? Payments to physicians/non-physicians who have contracted with MA organizations generally are governed by the terms of the contract. It is up to the MA organization whether to take eligibility for a PQRI or e-prescribing incentive payment into account in establishing the amount the physician is paid. If the MA organization offers a private fee-for-service (PFFS) plan that meets access requirements, that MA plan is required to pay the same as traditional Medicare for covered services (Part B Physician Fee Schedule). If the physician/nonphysician meets incentive eligibility for either the PQRI or the e-prescribing programs, that MA organization is required to pay an incentive amount. The amount of the incentive payment is calculated the same as for traditional Medicare (percentage of Medicare Part B estimated total allowed charges for PFFS plans). Physicians/nonphysicians who have not contracted with an MA organization, but who provide covered services to an enrollee in an MA plan, are also potentially eligible to receive PQRI and e-prescribing incentive payments from that MA organization. If the physician/nonphysician meets incentive eligibility, the physician/nonphysician should expect to receive an incentive payment from any MA organization which he or she has billed as a noncontracted provider, or for which he or she has provided covered services under a PFFS plan that meets access standards by paying the Medicare payment rate. The amount of the PQRI and e-prescribing incentive payment is calculated just as it is calculated for traditional Medicare for the reporting period. Q: Who reports the e-Rx performance, the physcian or pharmacy? If the physician does, how do we report it? A: The physician or eligible professional reports a G-code on specific denominator-eligible claims. Please review material on e-prescribing on the PQRI Web site at www.cms.hhs.gov/pqri. Q: Does e-prescribing require entry of all of a patient's medications into an electronic system? This would be time-consuming and cost-ineffective. A: You are not eligible for the e-Prescribing Incentive Program unless you have installed and are using a qualified e-prescribing system. This means that you maintain an updated active medication list, among other requirements. Please review materials posted on e-prescribing on the PQRI Web site at www.cms.hhs.gov/pqri. Q: Where do I find the e-prescribe codes? A: Please review material on e-prescribing on the PQRI Web site at www.cms.hhs.gov/pqri. Q: There was a reference made that the claim needs to be clean. Does this mean that we cannot refile due to wrong insurance information given to office by the patient? A: Claims may not be resubmitted merely to add or correct PQRI or eRx quality-data codes. Please read “Reporting Principles” delineated in the 2009 PQRI Implementation Guide. This can be downloaded from the Measures/Codes section of the CMS PQRI Web site at www.cms.hhs.gov/pqri. Q: How does it work if you begin e-prescribing or PQRI during the middle of the year? A: The target for reporting successfully in PQRI is 50% of eligible claims. You may want to consider reporting by May, at the latest, if you are using a qualified e-prescribing system.
Audience Questions Q: We are now doing exercise stress tests in our office. We are using CPT codes 94621, 82803 (2 units), and 36600 (2 units) We are receiving denials when we are trying to bill/code for those 2 units of the blood gases and the draws. Why are those getting denied? Are we billing/coding wrong? Q: We are not receiving full payment for the new exercise stress tests we are performing in our office. Code 94621 is being paid properly. They are bundling 82803 and 36600, which are a part of the test. A: (combining the two questions above) The codes for arterial puncture and blood gas analysis should not have been denied. To cite a timely review by Dr. Ed Diamond (Chest 2007; 132:2000-2007), “One or more arterial blood gas measurements may be included as a part of simple or complex pulmonary stress tests. Arterial blood gas analysis requires an arterial puncture (36600) or arterial catheterization (36620) to obtain the arterial blood sample and a blood gas analyzer to process the blood (82803). These codes may be submitted, as they are not bundled with 94620 or 94621 and are modifier 51 exempt.” Q: Codes 31628, 31624, and 31624 are all for bronchoscopy procedures. Will they be denied if used together? A: Multiple procedures can occur during one bronchoscopy session. This is nicely described by Dr. Alan Plummer in the current Coding for Chest Medicine 2008 by the ACCP (Chapter 9). He notes, “For example, bronchoscopy…might include a BAL (31624), a protected brush sampling (31623), and a transbronchial lung biopsy (31628), all during the same session. All three procedures should be reported: 31628, 31623, 31624. Always code the most complex code first, followed in order by the lower-complexity codes. However, the total reimbursement is not the sum of the individual reimbursements for each code. Rather, the total…is the most complex bronchoscopic procedure and the sum of the differences in reimbursement between each of the less complex codes and the base bronchoscopy code (31622)…” Q: Can I get clarification as to when to use code 78596 for Complete PFT? A: Code 78596 is a pulmonary quantitative differential (ventilation/perfusion) study. This is usually done in radiologic evaluation for patients, eg, prior to major lung resection or pneumonectomy, or before consideration of lung transplantation, to assess relative ventilation and perfusion of each lung. It is different from, complementary to, and billed entirely separately from usual pulmonary function testing. Q: How do you bill when a surgeon is doing the trach and peg and we are assisting with bronchoscopy in the trach placement. Do we bill for a diagnostic bronch? A: There is no code for the second operator lighting the trachea during tracheostomy. Our general recommendation has been to code the most appropriate service, ie, therapeutic bronchoscopy 31645, if secretions are lavaged and suctioned prior to the procedure, or 31622, diagnostic bronchoscopy, if the airway was inspected. In each case, document the findings appropriately. Q: The CPT manual says that only two of three key components have to be addressed in subsequent visits. Does Dr. DeMarco advise to ALWAYS address three components in documenting subsequent visits? A: That is true. However, you will not be documenting a complete review of systems on subsequent office visits. In not doing so, you will still only have a problem-focused history, which does not change the level of your coding. I did say that you MUST document all three for a New Consult or a New Patient. Q: What is the TrailBlazer Medicare area? A: The TrailBlazer Medicare area is CO, NM, OK, and TX.
Q: Can you bill for an albuterol treatment done in the office? A: Yes. You would use 94640 pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device) with the appropriate HPCPS J code. You would use: J7611 Albuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, 1 mg J7612 Levalbuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, 0.5 mg J7613 Albuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, 1 mg J7614 Levalbuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, 0.5 mg
Q: Is CPT code 99363 billed in addition to another Evaluation and Management (E/M) code or is it submitted alone? A: CPT 99363 Anticoagulant management for an outpatient taking warfarin can be submitted alone, and, if so, should not also form the basis for an E/M code. If a separate service is provided, E/M can also be reported using modifier 25. Medicare does not pay for CPT 99363,
Q: What is the arterial blood gas (ABG) coding during a cardiopulmonary exercise test (CPET)? A: If an ABG was performed during the CPET, you can bill for an arterial puncture, 36600, or arterial line placement, 36620, as well as for the ABG, 82803, if the SaO2 is calculated, or 82805, if the SaO2 is measured directly. Pulse oximetry cannot be billed on the same day any other service is performed on the patient.
Q: Where is the documentation on bronchoscopy codes 31615 through 31656 that modifiers are not needed for multiple procedures? A: The reference is Manaker S, Krier-Morrow D, Pohlig C, eds. Coding for chest medicine 2008. 12th edition. America College of Chest Physicians, Northbrook, IL: 2008; 133-142. Q: Do we always bill 31622, along with other codes? A: The only time you would bill 31622 is for a bronchoscopy during which no biopsies, BALs, or brushings were performed. If a biopsy, brush, or BAL was performed, you would code for that procedure (31625, 31623, 31624) and would not code 31622. CPT 31622 has a zero modifier indicating that a CCI edit with all the bronchoscopy codes and no modifier can be used to unbundle the edit. Q: Medicare denied code 31622 when billed with 99255 or 99291, stating 31622 was a component of E/M codes. I looked on the CCI spreadsheet, but code 31622 was not linked with the E/M codes as a flag. Was this denial correct? A: No, the denial was not correct. A bronchoscopy is not bundled with critical care and is not part of a consultation. As you have found, no CCI edits are present for these codes. You need to appeal the denial. Q: Can we bill a Consultation on the same day as a bronchoscopy? A: You can bill for a consultation on the same day as you performed a bronchoscopy on that patient as long as the consult documented that you had other medical reasons for seeing the patient than just preparing the patient for the procedure. You would need to add a 25 modifier to the consult code. Q: What is the appropriate bronchoscopy code to bill when suctioning mucus out? A: The appropriate code would be 31622, the basic bronchoscopy code. If there was a total atelectasis due to mucus plugging, then you could code 31645 for a therapeutic bronchoscopy.
Q: When one is coding for a central line placement, 36556, what minimally should be documented? A: You should describe the reason the procedure was performed, the use of informed consent, the position of the patient, the skin prep, the use of local anesthesia, the use of ultrasound, the insertion site, the sutures used, the dressing application, and results of the chest radiograph after the procedure. The description should be enough to convince an auditor that you actually performed the procedure. Q: Can failed procedures after they are attempted (central line, a-line, or others) be coded? A: Yes, you can code the failed procedure adding a 53 modifier, Discontinued Procedures, to indicate the procedure was shortened. If these procedures are attempted in an ambulatory care center (outpatient hospital/ASC), code the procedure with a 73 modifier if the failure occurred before anesthesia or with a 74 modifier if it occurred after anesthesia has been delivered.
Q: Is pleurodesis a separate code and charge in addition to placement of a chest tube? A: Chemical pleurodesis (eg, for recurrent or persistent pneumothorax). CPT 32560 is a separate procedure in addition to the placement of the chest tube. Note that CPT 32005 has been deleted in 2008 and renumbered 32560. There are five additional codes renumbered in the Lungs and Pleura Section: 32000 is now reported as 32421; 32002 is now reported as 32422; 32109 is now reported as 32550; and 32020 is now reported as 32551.
Q: If we have a patient that we have seen in our office, and at a later date, he is admitted to the hospital, can we bill an initial hospital consult code? (Example: 99254). A: Yes, you could bill that code if the patient was admitted under the care of another physician and that physician asked you for a consultation. If the patient was admitted to your service, then you would list an initial hospital visit code. Q: Documentation: is it enough to have documentation in the chart and dictate a short note to the primary physician, or do we need to send? A: It is important to communicate with the physician who requested the consultation and not rely on him or her to find your note in the chart. Q: If a patient is seen in the office for asthma exacerbation but gets admitted on the next day for worsening asthma, what level can we bill the hospital consultation? A: If you perform an evaluation and management service in the office for “asthma exacerbation” on Monday, then, when the patient is admitted to the hospital on Tuesday, you may not report a consultation code. You should report the initial hospital visit code (99221-99223), which is supported by your documentation. Q: Do we need to send a consultation and follow-up report to the primary physician who requested the consult? A: Absolutely, that is one of the criteria for the additional payment for reporting a consultation visit.
Q: We provide 24-hour ICU coverage. How do we bill for multiple physicians providing critical care during the same 24-hour period and/or billing for one physician in the group who performs a procedure, such as a bronchoscopy, and another who sees the patient. A: You must bill critical care for only one physician per 24-hour period (midnight to midnight). Internally, you have to develop a mechanism to credit the other physicians for the critical care they performed. The physician who performs the procedure should bill for the procedure, even if another physician performed the E/M on the patient. Q: If you are billing critical care time, do you still have to have three vital signs documented or can you write vitals reviewed? I have heard for critical care that you can write vitals reviewed in flow sheet/encounter form. A: If the vital signs are in the documentation, you do not need to rewrite the results.
Q: BCBSM doesn't cover professional charges for EBUS. Has your practice experienced this or are aware of any ways to appeal this decision? (They do cover technical charges). A: Professional charges for EBUS, CPT 31620, (an add-on, ZZZ code) should be reimbursed by BCBSM. If not, you should appeal to BCBSM. If you are talking about an APC, Medicare has bundled EBUS into the bronchoscopy APC with a small increase in payment for the transbronchial needle aspiration, 31629. ACCP and the ATS have appealed that decision. Q: If a patient is having a routine bronchoscopy and then there is a question of vascular involvement of an abnormality and the patient undergoes an endobronchial ultrasound (EBUS) at the same time, can the EBUS and TBNA both be billed? A: Yes. The EBUS code 31620 can be used with all bronchoscopy codes from 31622-31646 as noted in the parenthetical.
Q: Is it acceptable to put a statement in the medical record that the past medical and family and social history is unchanged compared to the last visit? A: No, you must report each separately and do this every time you report a consultation. Q: Office visit follow-up, duration, and severity; is this pertaining to the visit day's chief complaint or the chronic condition? A: This question addresses the History of Present Illness (HPI). For a follow-up visit, you can either discuss chronic condition(s) (eg, COPD, asthma) and score them depending on whether there are 1, 2, or 3 or more chronic conditions. If you are addressing a new problem in a follow-up visit, you would have to characterize it, and the duration and severity would relate to that problem. Q: What happens if the Review of Systems (ROS) is not obtainable if patient is intubated, demented, or unable to communicate? A: Document that the ROS cannot be obtained because the patient is intubated, demented, or unable to communicate, and there is no family/caregiver who can provide the ROS. Q: If you do not document percussion of chest or palpation of heart on physical exam, do you then not get credit for those systems? A: If something is done but not documented, you cannot receive credit for it. Q: If you just write labs were reviewed in the computer or vital signs were reviewed, do you still get credit for it? A: Yes. Q: For each follow-up visit, do we have to document ROS/PFSH even though it has not changed? A: You need to check with your patient’s insurance carrier to see if they will accept that documentation. For Medicare, you have to document them for each visit. Q: Can a 95810 for sleep testing be billed with an E/M service on same day? A: Yes it can. In the CCI edits, there is a “9” listed after 95810 and all the E/M codes; therefore, no edits apply. CPT 95810 and an appropriately documented separately identifiable evaluation and management (E/M) service can be performed on the same day, appended with modifier 25. This would be a rare occurrence. Q: Can CPAP management code 94660 be billed with an E/M code? A: No. CPAP, like ventilation management in the inpatient hospital/observation, is mutually exclusive of all E/M services during the same session by the same provider. Review page 266 of the ACCP Coding for Chest Medicine 2008 book. Q: If you document “continue present meds,” does it still fall under moderate risk? A: Yes. If the present prescription medications are continued, that would place that item in the moderate complexity category. You should have a plan for every problem that you document. For example: Complicated Community-acquired Pneumonia – continue present meds. It would be acceptable in this circumstance. Q: Clarify for documentation of a follow-up visit; is it appropriate to say it is unchanged from the initial consult? A: If it is unchanged, it is appropriate to document that it has not changed. Q: As a pulmonologist and sleep specialist, I spend a lot of time discussing management, CT scan results, sleep studies, and management of sleep disorders. Most of these are time- based. How do we do that best? A: You can bill for time, if the following criteria are met: You actually document the time, ie, 45 minutes, 3:00-3:45 pm. You describe in your note the content of counseling or coordination of care. More than half of the total time was counseling or coordination of care. Average times are noted in the AMA CPT book with each of the evaluation and management services and in the ACCP coding book in the tables on pages 64-68, 111-113 for critical care and page 283 for the teaching physician rule. Q: When the collaborating physician sees a patient after the nurse practitioner and then bills, does the MD/DO's note suffice to say: seen and examined as above, agree with treatment plan as outlined? A: Possibly. A better note would say: “I interviewed and examined the patient. I discussed the findings and the data with the NPP, and I agree with his/her findings, assessment, and plans.” Q: Do we append the 25 modifier to the E/M code if another physician does the procedure? A: Since the physician who performed the procedure did not perform an E/M service, no modifier is necessary. The physician who bills for the E/M service should not use a 25 modifier since he/she did not perform a procedure on the patient.
Q: Which ICD-9-CM code is best used for flu injection and also Kenalog injections that are done in the office? A: ICD-9-CM code for the flu vaccine is V04.81. Influenza virus vaccine codes pending FDA approval in CPT are 90661, 90662 and 90663 for 2008. For triamcinolone acetonide, report the underlying reason for the injection (eg, 477.0 Allergic rhinitis due to pollen). Triamcinolone acetonide shots may be used by some for exacerbations of asthma, 493.21 or 493.01, or for exacerbations of COPD, 491.21. Episodes of acute bronchitis affecting COPD or asthma patients could lead to a triamcinolone acetonide injection, and those diagnosis codes would be 491.22 for COPD and 493.22 or 493.02 for asthma. Use 90772 for triamcinolone acetonide injections with J3301.
Q: When giving a triamcinolone acetonide injection in the office, what is the CPT code and is there also a "J" code that goes along with that? A: The injection code would be 90772 (renumbered 96372 for 2009) Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular. The J code for triamcinolone acetonide is J3301 Injection, triamcinolone acetonide, per 10 mg. If you inject 40 mg of Kenalog, you would put 4 in the units box of the claim form.
Q: How do I code for monitoring alpha-1 replacement therapy? A: Alpha-1-antitrypsin is an IV infusion, the codes for which are: 90765 (renumbered 96365 for 2009), Intravenous (IV) infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour. CPT 90766 (renumbered 96366 for 2009) is used for each additional hour, for greater than 30 minutes beyond 1 hour. Also use the J code for the agent, J0256 Injection, alpha 1-proteinase inhibitor – human, 10 mg. Use this code for brands of alpha 1-proteinase inhibitor.
Q: Methacholine challenge: You mentioned that J7674 could be billed per methacholine dose. Would you please explain that billing? A: HCPCS code J7674 Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg, is used to report each milligram of methacholine used during the test. If 100 mg of methacholine was used, then you would code J7674x100. Q: Do you perform methacholine challenge in office or hospital setting only? A: Methacholine challenges can be performed in the office and the hospital settings. Q: If the patient does not show up for a methacholine challenge, can the methacholine doses be charged? A: You can't charge Medicare, but you can create a practice policy that no shows are charged (personally, not their insurance) for the medication if it has already been mixed and is wasted. We have such a policy, and we inform patients of this policy as they schedule the test. We have very few no shows.
Q: What is the code for giving omalizumab in the office? A: Omalizumab (Xolair) is given by subcutaneous injection. The applicable code is 90772 (renumbered 96372 for 2009) Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular. Also code J2357 for the agent, per 5 mg. Some have argued that the work of preparation and the risk of the injection justify use of the chemotherapy code for subcutaneous injection, 96401, but this has not yet been approved by CMS or AMA.
Q: What about TPA or urokinase thru a chest tube? A: There is no code for pleurolysis. Some practices report the pleurodesis code, but most correct appears to be reporting an unlisted procedure, CPT 32999, Unlisted procedure, lungs and pleura. A complete description of the procedure performed should also accompany the claim to facilitate payment.
Q: I didn't see 519.19 (Other diseases of trachea and bronchus) listed as a diagnostic code for medical necessity for a bronchoscopy. Does this code qualify? A: You would have to check with your local Medicare carrier. It would not support medical necessity for bronchoscopy in Georgia.
Q: What are the PFT codes? A: The PFT codes are pulmonary function tests and are listed in Chapter 14 of ACCP’s Coding for Chest Medicine 2008, pp 189-203. Q: Can a 6-min walk test be billed with a spirometry on the same day? A: Sometimes. If done with the exercise testing or at the same session, it is considered a bundled service and not billed separately. If performed separately from the exercise testing, eg, at a different session or encounter, the spirometry could be billed, appending a 59 modifier. Q: Can office spirometry or a 6-min walk test be billed the same day as an E/M code? A: Yes. Most carriers allow the E/M reported without a modifier, and with the same primary diagnosis, although any additional documentation for the evaluation and management strengthens the case for additional billing of PFTs performed on the same day. Q: Can a prespirometry and postspirometry and a 6-min walk test be billed the same day? A: Usually not, since it is considered a bundled procedure. But if the tests were clearly separate in time and purpose, eg, bronchospasm evaluation and later a 6-min walk, you can bill spirometry separately with a 59 modifier to indicate the distinct service. Q: How often can you bill a full PFT? A: A specific number (frequency per year) or for another time period has not been published. Frequently repeated tests have been denied payment by some carriers. Documentation can be submitted to justify the testing, eg, repeat of full PFT and Dlco during treatment of interstitial lung disease. CMS (Medicare) has frequency edits that are not published called Medically Unlikely Edits (MUE). These edits have been reviewed by the medical specialties. If you encounter an inappropriate denied payment, appeal with justification for the repeated PFTs. Q: What if you do pulse oximetry? A: Codes 94760 (single determination), 94761 (multiple determinations), and 94762 (continuous overnight) describe oximetry. CPT 94760 and 94761 are identified by Medicare as T codes, meaning that they cannot be reported if performed on the same day with any other procedure. Q: When we read full PFTs, should we bill 93722 instead of 94060-26, 94720-26, and 94250-26? A: No. You would bill 93722 in addition to the codes you have listed with the 26 modifier. No modifier is required for 93722. Q: Can simple exercise testing be billed on the same day as an evaluation and management (E/M) code? A: Yes it can (CPT 94620), and no modifier is required. Q: Has Medicare stopped paying for thoracic gas volume code 94260-26? A: No. If you have not been reimbursed by Medicare for this code, appeal. Q: Can we bill 94760 and 94010 or 94060 in the same visit at the office setting? A: No, you cannot. You could bill the spirometry, 94010 or 94060, but not 94760, oximetry, as it is not reimbursed by Medicare if performed with any other service on the same day.
Q: Does pulmonary rehabilitation require supervision from an MD/DO? A: Yes, it does in the office setting. Review Chapter 15 in the ACCP Coding for Chest Medicine 2008 book. The physician should be in the area for outpatient pulmonary rehabilitation but does not have to be physically present in the area for a hospital or CORF facility. The program should have the overall supervision of a pulmonologist.
Q: Can you bill for a spirometry and walking oxygen on the same day? A: The Medicare Physician Fee Schedule is the appropriate reference for this question, not the CCI edits. It designates “T” status for 94760 and 94761. “T” status is defined as follows: There are RVUs and payment amounts for these services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the physician services for which payment is made. Other third party payers, if they do not follow Medicare, have other rules regarding pulse oximetry performed on the same day with any other service.
Q: What is the nebulizer treatment code when done in the office? A: The code is 94640, whether the bronchodilator was delivered with a nebulizer or a MDI.
Q: We can't bill for smoking cessation counseling if a nurse practitioner sees the patient? A: Do not report tobacco cessation counseling codes when a nonphysician provider sees patient “incident to” a physician. Rather, use an appropriate established patient E/M code. Nonphysician providers can report smoking cessation codes as an independent provider. Note for 2008, the new smoking cessation codes are 99406 (replacing G0375) for 3 to 10 min, or 99407 for greater than 10 min. Smoking cessation counseling under 3 min is included in the reported E/M code.
Q: If the physician performs a thoracentesis in the hospital with an ultrasound, do we charge the 76942 with a 26 modifier and the thoracentesis code? A: Yes. You may charge for the ultrasound so long as you document how you did the procedure. It helps to attach a photo of the ultrasound picture with the report. Note: The thoracentesis codes have been renumbered for 2008 as 32421 and 32422.
Q: CPT 76942 has been denied as a bundled payment used with 32002. Why? A: As described above, code 32002 has been deleted, and for 2008 is replaced by 32422 Thoracentesis with insertion of tube, includes water seal (eg, for pneumothorax), when performed (separate procedure). CPT 76942 can be reported separately for ultrasound imaging supervision and interpretation. Q: Please give an example of appropriate documentation for ultrasound with thoracentesis? A: Typically, you would write or dictate a procedure note describing the thoracentesis and a separate report for 76942, ultrasound guidance for needle placement. If the physician owns the equipment, the full imaging code is billed. If the thoracentesis is performed in a facility, code 76942 with modifier 26 to report the physician component, or professional interpretation only.
Q: Does 94005 include BIPAP or CPAP? A: Ventilator management codes can be used for the titration of noninvasive positive pressure ventilation. (Avoid the use of the term BiPAP, since it is proprietary.) Ventilator management may be coded for initiation of CPAP for acute respiratory failure but may be challenged, since CPAP has its own code, 94660 (usually used for diagnosis of obstructive sleep apnea). Documentation should include the diagnoses for which positive pressure support is needed, ie, acute hypoxemic and/or hypercapnic respiratory failure.
Q: Which education codes do you use in the office setting? A: CPT Education and Training for Self-Management codes, 98960-98962 may be paid by some insurers but currently are not paid by Medicare. Q: What would be the appropriate codes for a Montgomery T-tube removal? Unlisted procedure w/notes? or 31638 and 31502? A: There is no CPT code for the removal of a Montgomery T-tube or for the removal of any tracheostomy tube. The removal of any of these tubes adds to the complexity (and, therefore, the level) of the E/M service provided when the tube was removed. |
||||||||||||||||||||||||||||
 |
||
|
||
|
||
|
||
|