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Main CPT Codes for Respiratory and Pulmonary Medicine in 2017

by | Aug 10, 2017 | Medical Coding News, Resources | 0 comments

According to new research published in Nature Climate Change, the amount of ground-level ozone and fine particle pollution caused by climate change is set to increase the incidence of lung disease, heart conditions, and stroke. As clinicians in respiratory medicine deal with the growing patient influx, they need to be aware of the CPT code changes, revisions and new codes in 2017. The ideal way to stay up to date with coding, billing, and payment updates for respiratory therapy services is through medical billing outsourcing.

Though respiratory therapists cannot bill any insurer directly for their services, providers are responsible for accurately, completely, and legibly documenting the services performed. This will allow their facility’s medical billing company to submit claims for services rendered using valid HIPAA-approved codes in accordance with industry standard coding guidelines and coverage policies. Let’s take a look at some key respiratory codes for 2017.

  • Smoking Cessation Codes
  • CMS revised its national coverage decision to cover smoking and tobacco use cessation counseling for outpatient and hospitalized Medicare beneficiaries who use tobacco, regardless of whether they have signs or symptoms of tobacco-related disease. As of October 1, 2016, Medicare no longer differentiates between symptomatic and asymptomatic patients.

    Medicare covers both symptomatic and asymptomatic patients if they:

    • Use tobacco, regardless of whether they exhibit signs or symptoms of tobacco-related disease
    • Are competent and alert at the time of counseling
    • Receive counseling furnished by a qualified physician or other Medicare-recognized practitioner

    Codes G0436 and G04037 which represented asymptomatic cessation counseling were deleted. Effective October 1, 2016, the following HCPCS/CPT codes are used to bill for smoking and tobacco use cessation counseling

    99406 – Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes

    99407 – Smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes

    (99407 should not be reported in conjunction with 99406)

    Medicare pays for two individual smoking cessation counseling attempts per year. Each attempt may include a maximum of 4 intermediate OR intensive sessions, with the total benefit covering up to 8 sessions in a 12-month period. If one of the services mentioned above is provided on the same day as a scheduled office visit, Modifier 25 should be appended to the appropriate E/M code to show that the E/M service is a separately identifiable service from smoking cessation counseling, for example: 99213-25 plus 99406.

    Under current guidelines, respiratory therapists can furnish smoking cessation counseling as “incident to” a physician’s service under Medicare Part B. Only the physician or other qualified healthcare professional recognized by Medicare can bill Medicare directly for the service.

  • Inhaler Techniques
  • For demonstration and/or evaluation of inhaler techniques, including demonstration of flow-operated inhaled devices such as flutter valves, use the following code:

    94664 – Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device can be used demonstrating (teaching) patients to use an aerosol generating device property

    • This code may only be used once per day
    • It cannot be billed at the same time/ same visit as 94640
    • If billed on the same day, these codes must be for a separate patient visit
  • Self-Management Education and Training Services (including Asthma)
  • The codes for this service are not separately billable under Medicare and are not paid by Medicare when submitted for any outpatient bill type. If the service is covered, payment for it would be bundled into the payment for other services for which the patient is being treated.

    98960 – Education and training for patient self-management by a qualified, non-physician health care professional using a standardized curriculum, face-to-face with the patient (can include caregiver/family) each session 30 minutes: individual patient.

    98961 – 2 – 4 patients

    98962 – 5 – 8 patients

    Private payer guidelines may differ for these codes.

  • Inhalation Treatment for Acute Airway Obstruction
  • 94640 – Pressurized or non-pressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device.

    • According to CMS’ policy effective January 1, 2017, if inhalation treatments are administered as an outpatient service, including services administered in the Emergency Department, CPT code 94640 should only be reported once during an episode of care regardless of the number of separate inhalation treatments that are administered.
    • If CPT code 94640 is used for treatment of acute airway obstruction, spirometry measurements before and/or after the treatment (s) should not be reported separately.
    • For more than 1 inhalation treatment performed on the same date append modifier 76
    • Do not report 94640 in conjunction with 94060, 94070 or 94400
    • CPT codes 94644 and 94645 should be reported instead of CPT code 94640 if inhalation drugs are administered in a continuous treatment or a series of “back-to-back” treatments exceeding one hour.

    94644 – Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour

    94645 – Each additional hour

  • Ventilation Management including CPAP
  • 94002 – Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing, hospital inpatient/observation, initial day

    94003 – Hospital inpatient/observation, each subsequent day

    94004 – Nursing facility, each day

    94660 – Continuous positive airway pressure ventilation (CPAP), initiation and management

    94662 – Continuous negative pressure ventilation (CNP), initiation and management
    –    Do not report 94002-94004 in conjunction with Evaluation and Management services 99201-99499)

    –    If the patient in the ED is admitted as a hospital inpatient in the same facility, 94002 may be reported for the ventilator

    –    Ventilation management CPT codes (94002-94004 and 94660-94662) are not separately reportable with evaluation and management (E&M) CPT codes

    –    If an E&M code and a ventilation management code are reported, only the E&M code is payable

  • Pulmonary Rehabilitation
  • Pulmonary rehab services are provided to patients with moderate to very severe COPD. The relevant codes for 2017 are:

    G0424 – Pulmonary rehabilitation, including aerobic exercise (includes monitoring), per session, per day

    G0237 – Therapeutic procedures to increase strength or endurance or respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring)

    G0238 – Therapeutic procedures to improve respiratory function, other than described by G0237, one on one, face to face, per 15 minutes (includes monitoring)

    G0239 – Therapeutic procedures to improve respiratory function or increase strength or endurance or respiratory muscles, two or more individuals (includes monitoring)

  • Pulmonary Function Testing
  • 94010 Spirometry Complete, includes graphic record total and timed vital capacity, expiratory flow rate measurement(s) with or without maximal voluntary ventilation (94010 should not be reported with 94150, 94200, 94375, 94728)

    94060 Bronchodilation Responsiveness, spirometry as in 94010, pre- and post bronchodilator or exercise (94060 should not be reported with 94150, 94200, 94375, 94640, 94728)

    94150 – Vital Capacity, total (separate procedure) (94150 should not be reported with 94010, 94060, 94728)

    94200 – Maximum breathing capacity, maximal voluntary ventilation (94200 should not be reported with 94010, 94060)

    94375 – Respiratory Flow Volume loop (94375 should not be reported with 94010, 94060, 94728)

    94726 – Plethysmography for determination of lung volumes and, when performed, airway resistance (94726 should not be reported in conjunction with 94727, 94728)

    94727 – Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes (94727 should not be reported in conjunction with 94726)

    94728 – Airway resistance by impulse oscillometry (94728 should not be reported in conjunction with 94010, 94060, 94070, 94375, 94726)

    94729 – Diffusing capacity (e.g., carbon monoxide, membrane) (List separately in addition to code for primary procedure) (Report 94729 in conjunction with 94010, 94060, 94070, 94375, 94726-94728)

The American Association for Respiratory Care strongly recommends that providers perform insurance eligibility verification and verify payer coding requirements before providing a service as benefits are subject to specific plan policies which can vary among both public and private payers. This is possible with reliable medical billing service support.