Vol. 17 •Issue 1 • Page 12
Coding Connection Q & A
Ventilator Management
Q:Can you explain why vent management codes (94002-94005) aren’t to be billed in combination with evaluation and management (E/M) codes? As far as cost, is it better to use vent management or E/M codes?
A: Vent management codes, like most simple procedures, are bundled into all E/M codes because they’re normal and integral parts of any hospital visit for a patient on a ventilator. They can’t be coded with any E/M visit code.
A situation in which they might be used by themselves would be when other providers are managing the patient’s various disorders, the patient is vent-dependent, and the pulmonary provider is working only with the ventilator management with respiratory therapy.
A common situation would be on a post-surgery patient when the surgeon needs assistance in slowly weaning the patient from a ventilator. It’s not billed commonly on a daily patient unless that’s the only area the pulmonary provider is managing on a given day.
CPT CODE FOR ACAPELLA®
Q: Is there a valid CPT code for the use of the Acapella on a patient and the minute unit value allotment for the therapy?
A: Acapella is a device used to open airways and mobilize secretions. There’s currently no specific CPT code for its supply or use.
OXYGEN IN THE SLEEP CENTER
Q: What’s the CPT code for oxygen use during PSG/CPAP/bi-level?
A: There’s currently no specific CPT code for its supply or use because CPT is specifically for physician services, not supplies. Sleep centers can’t charge for supply of oxygen.
CPT CODE FOR AIRWAY MANAGEMENT
Q: What’s the CPT code for airway management?
A: Beyond intubation (31500) and ventilator management (94002-94003), there are no specific codes in CPT for airway management.
CPT generally describes “provider” services, such as physicians, and generally doesn’t provide codes that describe hospital employee services, such as respiratory therapists providing overall airway management for patients.
NEBULIZER INSTRUCTION IN THE HOME
Q: Can a non-respiratory therapist give instructions on nebulizer operation in a home care setting?
A: As long as the individual has training at least as a medical assistant and is giving the instructions under the order of a physician, this shouldn’t be a problem. Be sure the person is under the general supervision of a physician/medical director and is trained properly.
PSG INTERPRETATION
Q: If a physician pulls a polysomnogram report from an Internet database/compliance software and reads/charts the report, what code should be billed?
A: The physician is interpreting a polysomnogram or a CPAP titration study. The proper coding is 95810-26 for the polysomnogram interpretation and 95811-26 for the CPAP titration study.
OFFICE VIST AND EDUCATION ABOUT HOME CPAP
Q: We’re considering using CPT 98960 for the office visit and education portion of the patients we’re setting up on home CPAP/APAP equipment. Can you give us any input regarding this code and its appropriate use?
A: The education and training for self-management codes require a “standardized curriculum” be followed. I’m told the curriculum must be “industry standard” and not just something you’ve created yourself. I’m not aware that there’s any standardized teaching for CPAP training.
The more appropriate code to use would be 94660 — “Continuous positive airway pressure ventilation (CPAP), initiation and management,” which was created for the teaching and periodic re-training and management of OSA patients on home CPAP (not to be used for patients on a ventilator with CPAP/bilevel).
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: 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. Procedures that allow moderate sedation don’t include all bronchoscopies, only those that aren’t listed in CPT Appendix G.
Editor’s note: This is a clarification of an answer that appeared in the November 2007 issue.
Ray Cathey, PA-C, MHA, FAHC, CHCC, is the president/owner of Medical Management Dimensions in Stockton, Calif.
