Respiratory Compliance Question of the Week
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January 23, 2012
Question:
Our physicians order a complete pulmonary function test (PFT), which we perform along with an ABG. The completes are performed differently due to different machines, meaning one room we charge for airway resistance and plethysmography and the other two rooms we charge nitrogen washout. Are we compliant since they are performed as a complete PFT?
Answer:
Ordering physicians should specify the tests to be performed to satisfy Medicare’s requirement for individualized care and to mitigate the risk of revenue reversal. If your facility currently uses a preprinted order form and has already defined these tests, add the components defined in the protocol to the order form. This shows that the physician readily knew what he or she was doing and had the opportunity to add and/or subtract tests that were indicated for the patient. Listing individual tests on preprinted order forms and allowing physicians to select those that are appropriate for individual scenarios is the best practice.
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January 16, 2012
Question:
Can positive expiratory pressure (PEP) treatments be charged the same as chest physiotherapy?
Answer:
By itself, PEP does not exactly fit the definition of CPT code 94667 and 94668, which identify chest-wall manipulation, such as cupping, percussing, and vibration to facilitate lung function; initial and subsequent days demonstration and/or evaluation. Unlike labor-intensive, time-consuming chest physiotherapy (CPT), PEP therapy can generally be self-administered by the patient. We recommend that you review your current Medicare contractor’s local coverage determinations (LCDs) for respiratory servcies for exact coding guidance before reporting PEP services using CPT code 94667 or 94668.
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January 9, 2012
Question:
What code should be used to report thoracic gas volume?
Answer:
Up until January 1, 2012, you would report code 94260. For 2012, however, the following codes should be considered instead since 94260 has been deleted: 94726 or 94727.
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January 2, 2012
Question:
When we report a code for pulmonary diagnostic testing, can we also report an E&M code?
Answer:
According to the American Medical Association in the 2012 CPT Manual, the answer is yes—if a separate identifiable evaluation and management service is performed.
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December 26, 2011
Question:
What happened to the “other procedures” section in the CPT manual for 2012?
Answer:
Before 2012, the CPT manual pulmonary section contained the nondescript subheading “Other Procedures.” That subheading has now been renamed “Pulmonary Diagnostic Testing and Therapies.” The purpose of the change is to highlight that this section of CPT contains those specific types of services.
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December 19, 2011
Question:
Can we report code 94010 (spirometry) with code 94150 (vital capacity)?
Answer:
According to the 2012 CPT Code book, the answer is no, you may not. The American Medical Association added a parenthetical note after 94010 indicating this instruction. There also are a few other codes that you can’t report with 94010 so be sure to check your 2012 manual.
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December 12, 2011
Question:
What diagnosis code should be assigned for air leaks that occur following an operation?
Answer:
For fiscal year 2012, postoperative air leaks should be reported with new code 512.2. Up until October 1, 2011, when FY 2012 changes took effect, providers assigned 512.1 (iatrogenic pneumothorax). However, this was thought to be confusing since patients can have an air leak without pneumothorax after surgery. To report either of these, physician documentation must indicate that the condition occurred postoperatively or as a result of a procedure performed.
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December 5, 2011
Question:
How should we code for pulmonary insufficiency following surgery?
Answer:
The diagnosis of pulmonary insufficiency following trauma and surgery (518.5) now includes the following new codes:
518.51 Acute respiratory failure following trauma and surgery
518.52 Other pulmonary insufficiency, not elsewhere classified, following trauma and surgery 518.53 Acute and chronic respiratory failure following trauma and surgery
As indicated, use code 518.52 to report pulmonary insufficiency following surgery or trauma. Also use this code for adult respiratory distress syndrome in addition to shock lung related to trauma and surgery.
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November 28, 2011
Question:
How have the diagnosis codes for novel influenza changed for next year?
Answer:
First, when it comes to ICD-9-CM code changes, “next year” began on October 1, 2011. So for FY 2012, changes were made to novel influenza codes (for the third time in a row, in fact).
New subcategory 488.8 (influenza due to novel influenza A) has been added, and there are three related codes (virus identified with pneumonia, with other respiratory manifestations, and with other manifestation).
Also, three codes have changed for the 2009 H1N1 influenza (previously called the 2009 pandemic influenza). Previously, references to “novel” were included in the descriptor but “2009” has been inserted in place of that word.
488.11 Influenza due to identified 2009 H1N1 influenza virus with pneumonia
488.12 with other respiratory manifestations
488.19 virus with other manifestations
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November 21, 2011
Question:
Was there a specific reason the ICD-9 diagnosis codes for respiratory procedures were revised for 2012?
Answer:
As a result of a proposal from The Agency for Healthcare Research and Quality (AHRQ), unique ICD-9-CM diagnosis codes were added to distinguish postoperative acute respiratory failure from acute respiratory failure due to a disease process within the existing axis of ICD-9-CM codes. See the full descriptions of the following codes, which took effect for discharges on and after October 1, 2011: 518.51, 518.52, 518.53, and 997.32.
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November 14, 2011
Question:
Can smoking cessation services be provided via telehealth?
Answer:
In the 2012 final rule for the Medicare physician fee schedule (MPFS), the Centers for Medicare & Medicaid Services stated that it is expanding the list of services that can be furnished through telehealth to include smoking cessation services. This change will affect services proposed for the telehealth list beginning in 2013.
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November 7, 2011
Question:
Does the 2012 CPT book include any significant changes in the surgery/respiratory section?
Answer:
For the codes assigned to procedures of the lungs and pleura (32035–32999), the American Medical Association has made many changes, including new and lengthy introductory guidelines and numerous new parenthetical guidelines under existing codes. It also revised several code descriptions and added new codes in this section.
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October 31, 2011
Question:
If home sleep testing (G0398–G0400) is performed in conjunction with a hospital-based outpatient department or hospital-based sleep laboratory, who is paid?
Answer:
Reimbursement will be made to the hospital according to outpatient prospective payment system (OPPS) rules. The related cost for physician interpretation should be billed separately
to the carrier/Part B Medicare administrative contractor (MAC) by appending modifier 26 to
the appropriate G code.
No additional charges are billed to the Medicare program for the device. The cost of a device that is not returned or that is determined to have been damaged is part of the department
overhead cost and does not represent a billable cost.
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October 24, 2011
Question:
I would like to provide our physicians with guidelines related to documentation for prescribing PAP devices for Medicare beneficiaries. Can I find these on the CMS web site?
Answer:
According to the Centers for Medicare & Medicaid Services, the following four documentation errors for PAP devices are the most common.
- No documentation for the treating physician’s initial face-to-face clinical evaluation conducted before the sleep study to assess the beneficiary for obstructive sleep apnea (OSA);
- No documentation that the Medicare-covered sleep study supports medical necessity;
- No documentation of the treating physician’s signed and dated order descibes the items dispensed; and
- No documentation of the treating physician’s face-to-face re-evaluation within the first three months (but no sooner than the 31st day) of initiating therapy. This shows improved symptoms of OSA and adherence to PAP therapy.
For the above information and more, go to the following web site and check under the Downloads section: http://www.cms.gov/MLNProducts/MLM/itemdetail.asp?itemID=CMS1252820
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October 17, 2011
Question:
Has the AMA issued any new category II codes related to tobacco cessation for 2012?
Answer:
Yes, the American Medical Association updated and posted its list of the latest Category II codes developed. To see the tobacco cessation codes that have been added, go to http://www.ama-assn.org/resources/doc/cpt/cpt-cat2-codes.pdf and look for the Therapeutic, Preventive, or Other Interventions section where they are listed.
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October 10, 2011
Question:
What are the requirements to report codes for polysomnography (95808–95811)?
Answer:
Sleep must be recorded and staged for a period of greater than six hours. When less than six hours of recording occurs, report the service with modifier 52. Supporting documentation should include the interpretation of test results, which should provide a definitive diagnosis and an outline of the suggested therapeutic intervention.
Since there are several issues that determine whether a procedure meets the diagnostic or therapeutic criteria for Medicare coverage, investigate that which applies to your state. In all cases, services must be deemed to be reasonable and necessary for the patient. Ensure proper medical necessity documentation is submitted by the physician and then on the claim form.
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October 3, 2011
Question:
In the case of an acute airway obstruction, we sometimes modify the oxygen therapy by administering a mixture of helium and oxygen in order to provide adequate oxygen saturation. How is this billed?
Answer:
Heli-ox may be billed as a non-routine supply with revenue code 0271.
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September 26, 2011
Question:
Under what conditions does Medicare cover oxygen therapy? And what code is used to bill for it?
Answer:
Medicare will cover this service as long as the need and the effectiveness for it is documented, and there is a written order for the oxygen. “Oxygen PRN” is not satisfactory for Medicare reimbursement. The physician’s order must state the oxygen device and/or the specific flow rate or concentration of oxygen desired. A prescription for “oxygen PRN” or “oxygen as needed” does not meet these requirements. An intermittent or PRN oxygen therapy order must include time limits and specific indications for initiating and terminating therapy.
If the Medicare contractor notes the use of continuous oxygen without periodic assessment of arterial PO2, it may request additional documentation to determine the medical necessity for the service.
There is no CPT code for oxygen, and hospitals should not bill for oxygen using the unlisted CPT code 94799. Hospitals should bill it with the revenue code 0271, designating it as a supply. It must be billed in “measurable” units, such as per liter, per hour, per quarter hour, per minute.
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September 19, 2011
Question:
What treatment modes apply to use of code 94640 (pressurized or nonpressurized treatment for acute airway obstruction or for sputum induction for diagnostic purposes)? Is there a limit on the number of times it can be reported?
Answer:
Code 94640 includes different modes of treatment including aerosol generator, nebulizer, metered dose inhaler (MDI), or intermittent positive pressure breathing (IPPB) device. This code can be reported multiple times for a single date of service. CCI edits will require modifier 76 or 77 for each added treatment in the outpatient setting.
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September 12, 2011
Question:
Can codes 94010 and 94200 be billed together?
Answer:
The current National Correct Coding Initiative edit for the code pair of 94010 and 94200 indicates that the CPT code 94010 will be allowed and that CPT code 94200 is bundled.
The procedure that is bundled (the component/column 2 code) would require additional information provided by the use of the modifier to explain the circumstance where both services should be paid. Providers are responsible for applying the correct modifiers to appropriately support the codes they report. Use of modifiers where documentation in the medical record does not support the clinical circumstances and/or justify application of the modifier is considered an abusive billing practice.
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September 5, 2011
Question:
We are billing inhaled nitric oxide as J3490 (unclassified drug) per hour per our vendor’s recommendation, but we are not receiving reimbursement. Can you offer any advice for changing that?
Answer:
In our experience, payment for nitric oxide treatments typically require prior authorization with the payer regardless of the HCPCS code assigned.
The unique HCPCS code S1025 that once described INO was deleted a few years ago and no cross-reference was provided. At this time, there is not a unique HCPCS that defines nitric oxide. MedLearn has historically viewed the coding of nitric oxide as a measured gas rather than a drug and has recommended coding as a supply with revenue code 271.
Based on available literature, the most probable scenario for INO therapy includes term and near-term newborns (i.e., > 34 weeks gestation) less than 14 days old, who require mechanical ventilation for hypoxic respiratory failure. As a therapy provided during an inpatient stay, the reporting of a unique HCPCS code on the claim is not applicable. However, during the final coding of an inpatient medical record an ICD-9-CM procedure code of 00.12 may be assigned for the administration of inhaled nitric oxide. For nitric oxide challenge during cardiac catheterization, refer to the CPT code 93463.
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August 29, 2011
Question:
Which code should be assigned for thoracic gas volume — 93720 or 94260?
Answer:
Some respiratory care departments have assigned CPT code 93720 (total body plethysmography) to the procedure for thoracic gas volume. This code refers to a vascular assessment that includes measurement of thoracic gas volume, compliance of the lung, airway resistance and airway conductance.
When determining which code—93720 or 94260—most accurately represents the procedure to be billed consider the documentation and billing requirements of all payers including Medicare.
According to the CCI edits, 94260 is a component of 93720, which represents the global fee for a diagnostic pulmonary evaluation that measures thoracic gas volume, compliance of the lung, airway resistance and airway conductance. You cannot bill both codes on the same date of service. In fact, if you report the CPT code 93720, you cannot bill for CPT code 94360 (airway flow resistance) or CPT code 94750 (pulmonary compliance study) for the same encounter.
Unless clinical circumstance justifies appending a modifier, this code may be denied when used on the same date of service with 94240 (functional residual capacity [FRC]) (94240) for certain diseases. Investigate coverage criteria published by your Medicare payers.
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August 22, 2011
Question:
What claims for oxygen equipment for M&S will be accepted for payment?
Answer:
According to the Centers for Medicare & Medicaid Services, claims with the base HCPCS code for the oxygen equipment and the MS modifier for its maintenance and service (M&S) will be accepted for payment.
For more on this policy, see http://www.cms.hhs.gov/transmittals/downloads/R1177CP.pdf or
http://www.cms.hhs.gov/mlnmattersarticles/downloads/MM5461.pdf.
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August 15, 2011
Question:
Do respiratory therapists have to revalidate their Medicare enrollment under CMS’s newly announced policy?
Answer:
All providers and suppliers who enrolled in Medicare prior to March 25, 2011, must revalidate their enrollment information between now and March 23, 2013. However, this must be done only after receiving notification from their Medicare administrative contractor (MAC), says CMS in SE1126 at http://www.cms.gov/MLNMattersArticles/downloads/SE1126.pdf. CMS also says that MACs are sending out notices on a regular basis to begin the revalidation process for all providers and suppliers.
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August 8, 2011
Question:
Can CPT 94640 be charged for nebulizer treatments if the medication being delivered is a medication the patient receives at home by nebulizer?
Answer:
The oversight of routine maintenance therapy or continuation of home meds is no longer defined in CPT. By definition the CPT code 94640 represents the treatment of an acute airway obstruction.
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August 1, 2011
Question:
Are the drugs and supplies included in the treatment described by CPT code 94640?
Answer:
The drug is billable. However, you must follow payer guidelines in order to accurately report the charge on the claim. The inhaled drug meets the Medicare definition of self-administrable. When billing the Medicare program, a self-administrable drug is reported on the claim with revenue code 637 and billed as non-covered.
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July 25, 2011
Question:
Were the answers to the respiratory question posted on July 11 correct? For example, the question asks: “If a ventilator patient dies in the ED or is transferred to another facility, are facilities able to charge for the ventilator?” However, our chargemaster staff told us that we cannot charge for an ED ventilator if the patient dies or is transferred to another facility.
Answer:
Your chargemaster staff is correct. The answer we provided was incomplete. The CPT code for ventilator management does not include services provided in the emergency department (ED). The services of RT staff and ventilatory management provided in the ED are captured within the level of care (evaluation and management code) reported for the encounter. We apologize for any confusion our answer caused.
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July 18, 2011
Question:
Will Medicare pay for a pulmonary function test if there is no physician interpretation?
Answer:
t’s fine if the interpretation isn’t complete when you bill—as long as you’re billing services with the technical component (TC) modifier. However, physician interpretation should be done within a reasonable amount of time, which generally means within 48 to 72 hours. Each hospital will have to define “reasonable amount of time.”
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July 11, 2011
Question:
If a ventilator patient dies in the ED or is transferred to another facility, are facilities able to charge for the ventilator?
Answer:
The CPT code for ventilator management does not include services provided in the emergency department (ED). The services of RT staff and ventilatory management provided in the ED are captured within the level of care (evaluation and management code) reported for the encounter.
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July 4, 2011
Question:
In your answer to last week’s question about codes for stop-smoking counseling, you forgot to mention codes G0436 and G0437, which recently took effect. The codes are for the asymptomatic patient.
Answer:
You are correct that the following codes took effect in 2011:
G0436 - Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes
G0437 - intensive, greater than 10 minutes
However, the questioner wanted to know what codes replaced G0375 and G0376 specifically, which is why we didn’t include the above in the answer.
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June 27, 2011
Question:
What are the two CPT codes for smoking and tobacco use cessation counseling services that replace the temporary HCPCS codes G0375 and G0376 previously used for billing these services?
Answer:
For services provided on and after January 1, 2008, the following codes should be used. 99406 Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes; and 99407 Smoking and tobacco-use cessation counseling visit; intenseve, greater than 10 minutes For details on these codes, go to http://www.cms.hhs.gov/transmittals/downloads/R1433CP.pdf and http://www.cms.hhs.gov/mlnmattersarticles/downloads/MM5878.pdf.
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June 20, 2011
Question:
Is it OK to charge for oxygen delivered through ventilators and BiPAPs?
Answer:
Some providers calculate the average cost of oxygen and bundle that cost into the ventilator charge. However, because usage varies by patient, providers should classify oxygen as a supply and bill under UB-04 revenue code 271. No HCPCS codes are required, and none should be reported. Oxygen is billable when a valid order is present and measurable units of service are documented.
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June 13, 2011
Question:
Is it OK to charge for oxygen delivered through ventilators and BiPAPs?
Answer:
Some providers calculate the average cost of oxygen and bundle that cost into the ventilator charge. However, because usage varies by patient, providers should classify oxygen as a supply and bill under UB-04 revenue code 271. No HCPCS codes are required, and none should be reported. Oxygen is billable when a valid order is present and measurable units of service are documented.
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June 6, 2011
Question:
What is the intent of code 94720 and 94725?
Answer:
Diffusion capacity measurement is often indicated when spirometry and lung volume studies reveal restrictive disease. Diffusing capacity of the lung (DLCO) is used to distinguish between chest wall and interstitial disease. Diffusion capacity is also useful in quantifying the degree of parenchymal destruction in COPD and assessing pulmonary vascular diseases and interstitial diseases, even if vital capacity is normal. DLCO increases in cases of polycythemia and with increased pulmonary blood flow as seen in early heart failure.
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May 30, 2011
Question:
What is the Medicare policy for pulmonary rehabilitation services?
Answer:
Since October 4, 2010, Medicare has covered pulmonary rehabilitation items and services for patients with moderate to very severe chronic obstructive pulmonary disease (COPD) (defined as GOLD classification II, III and IV), when referred by the physician treating the chronic respiratory disease. Pulmonary rehabilitation programs must include certain components, which are listed in Chapter 32, section 140.4, of the Medicare Claims Processing Manual at http://www.cms.gov/manuals/downloads/clm104c32.pdf. Other guidelines are provided in this section as well.
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May 23, 2011
Question:
Can code 94250 (expired gas collection, quantitative, single procedure [separate procedure]) be billed with other respiratory codes?
Answer:
Billing for the expired gas collection in addition to any of the respiratory therapy codes—94620, 94621, 94680 and 94681 as included in the correct coding initiative (CCI) edits will result in double billing—and a claim denial. To report a determination for expired nitric oxide, refer to CPT code 95012.
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May 16, 2011
Question:
We want to develop documentation guidelines for pulmonary function testing. Could you provide any for us?
Answer:
One of the most important guidelines is that documentation supporting the medical necessity of these tests, such as ICD-9-CM diagnosis codes, must be submitted on all claims. Claims submitted without this information will be denied as not medically necessary. In addition:
• All providers of pulmonary function tests should have on file a referral (a prescription) with clinical diagnoses and requested tests. Indications for the studies should be clearly described in the clinical records and available for review.
• All equipment and studies should meet minimum standards outlined by the American Thoracic Society.
• Spirometry studies, in particular, require a minimum of three attempts that must meet minimum acceptability criteria.
• All studies require an interpretation, with a written report. Computerized reports must have a physician’s signature, attesting to its accuracy.
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May 9, 2011
Question:
When billing codes G0237–G0239, how should therapy notes be recorded?
Answer:
We recommend that the beginning and ending time of each modality of exercise be recorded in the patient’s health record along with the note describing the prescribed goal and the patients progress toward that goal. The therapists daily notes should support the plan to advance the intensity and duration of exercise as tolerated by the patient.
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May 2, 2011
Question:
What respiratory-related MS-DRGs are RACs reviewing during their reviews?
Answer:
The answer to this depends entirely on your recovery audit contractor (RAC). For a list of RACs and their web sites, go to http://www.cms.gov/RAC/Downloads/RACcontactinfo.pdf, and check under “Issues.”
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April 25, 2011
Question:
Will Medicare cover the codes listed in the CPT code book for patient-initiated spirometric recording per a 30-day period?
Answer:
Generally, CPT codes 94014, 94015, and 94016 are not covered by Medicare since their clinical efficacy has not been established, even though the Centers for Medicare & Medicaid Services (CMS) have assigned APCs to 94014 and 94015. Many states have coverage policies for this procedure, so you check with your Medicare payers for coverage polices relevant to your facility.
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April 18, 2011
Question:
If a physical therapist conducts assessments and individual treatment services as part of a pulmonary rehab program, can the PT codes be separately billed?
Answer:
No, physical therapists cannot bill PT codes separately if they conduct assessments and individual treatment services as part of a pulmonary rehab program. The PT services are included as part of the overall treatment plan for PR and are to be billed using G0424.
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April 11, 2011
Question:
Can codes 95803 (actigraphy testing) and 95805 (multiple sleep latency or maintenance of wakefulness testing) be billed together?
Answer:
No, these two codes cannot be billed together. Actigraphy (95803) is a component of the procedure for multiple sleep latency or maintenance of wakefulness testing (95805).
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April 4, 2011
Question:
Can you provide billing guidelines for code 94375?
Answer:
The respiratory flow volume loop (94375) is considered an alternate method of calculating a standard spirometric parameter. Alternate methods of reporting identical or duplicative data should not be billed separately on the same date of service (DOS). Unit of service edits do exist for 94375, when multiple determinations are performed on the same DOS to complete a pulmonary assessment, only one unit of service is appropriate.
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March 28, 2011
Question:
Do you know whether the Region C RAC audits any MS-DRGs related to respiratory?
Answer:
You may find the answer to that question at Connolly’s web site: http://www.connolly.com/healthcare/pages/ApprovedIssues.aspx.
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March 21, 2011
Question:
On Medicare claims, can we separately report code 94680 (oxygen uptake, expired gas analysis; rest and exercise, direct, simple)?
Answer:
Code 94680 may be included in a comprehensive cardiopulmonary exercise test to assess disability. Based on the methodology used, the result (VO2) may be obtained by direct measure or calculation.
Calculated test results should not be separately reported to Medicare for reimbursement in addition to the tests that are performed to derive such calculations. When performed with either the simple or complex pulmonary stress test, the oxygen uptake procedures are considered a component and should not be separately billed.
When documentation supports the billing of the oxygen uptake in addition to the simple stress test, a modifier may be appended. When performing a complex stress test, the CCI indicates that the oxygen uptake is never separately billable. Check with your Medicare payers to determine coverage for your facility.
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March 14, 2011
Question:
Are the services of a respiratory therapist covered when provided in a skilled nursing facility?
Answer:
Medicare covers the full range of services that SNFs generally provide, either directly or under arrangements with any qualified outside source. As a result, the services of respiratory therapists are now covered when provided under arrangements made directly between the SNF and any qualified respiratory therapist, regardless of whether the therapist is employed by the SNF’s transfer agreement hospital.
See §50.8.2 of Chapter 8—Coverage of Extended Care (SNF) Services Under Hospital Insurance—at http://www.cms.gov/manuals/Downloads/bp102c08.pdf.
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March 7, 2011
Question:
How often can we report code 94664—demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device?
Answer:
Because of the phrase “demonstration and/or evaluation” providers can only report this code one time per date of service even if they provide both components.
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February 28, 2011
Question:
What code should be assigned for actigraphy?
Answer:
The 2011 CPT Manual includes code 95803 for this service. As the descriptor states, it is used for actigraphy testing, recording, analysis, interpretation and report (minimum of 72 hours to 14 consecutive days of recording). This code should not be reported more than once in any 14-day period, according to the parenthetical note following the code. Also, it should not be reported with codes 95806-95811.
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February 21, 2011
Question:
What is the correct diagnosis code to use for "acute respiratory distress"?
Answer:
In the Index to Diseases in the ICD-9 code book, you would look up the key term “Distress,” then respiratory, then acute (adult). The following code is listed: 518.82—other pulmonary insufficiency, not elsewhere classified.
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February 14, 2011
Question:
Can code 31295 (surgical nasal/sinus endoscopy) be reported with 31233?
Answer:
According to a parenthetical guideline in the 2011 CPT manual, code 31295 cannot be reported with 31233 nor with 31256 or 31267 when performed on the same sinus.
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February 7, 2011
Question:
Is there a code for injection of the iliac or femoral artery prior to using a closure device?
Answer:
Current National Correct Coding Initiative (CCI) information does not allow the injection prior to the use of a closure device. According to CCI, codes 75710 or G0278 should not be reported.
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January 31, 2011
Question:
We are having trouble getting paid when we report stationary and portable oxygen services on the same claim. Does Medicare have a policy against this?
Answer:
Here’s what the Centers for Medicare & Medicaid Services (CMS) stated in transmittal R839OTN. During the implementation of certain policies, Medicare contractors identified limitations in their systems that prevent the correct processing of certain portable oxygen services on home health claims. In cases where both stationary and portable oxygen services are billed on the same claim, the Fiscal Intermediary Shared System (FISS) is incorrectly moving the charges for the portable oxygen services reported on revenue code 0604 lines to lines for stationary oxygen services. As a result, the revenue code 0604 lines are transmitted to the common working file (CWF) with no charge amount and are rejected for this reason.
In transmittal R839OTN, CMS gave requirements to Medicare contractors that will allow claims with both stationary and portable oxygen services to be processed and paid correctly. Unfortunately, the implementation will not happen until July 5, 2011, but it will be effective for claims dating October 1, 2010 forward.
Transmittal R839OTN can be at http://www.cms.gov/transmittals/downloads/R839OTN.pdf.
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January 24, 2011
Question:
What are the most common claims errors related to positive airway pressure (PAP) devices?
Answer:
According to a fact sheet issued about PAPs by the Centers for Medicare & Medicaid Services, the most common errors when reporting procedures using PAP devices is no documentation. Examples of missing documentation include the following:
• The treating physician’s initial face-to-face clinical evaluation conducted prior to the sleep study to assess the patient for obstructive sleep apnea (OSA);
• Medicare-covered sleep study supporting medical necessity;
• The treating physician’s signed and dated order describing the item(s) dispensed; and
• The treating physician’s face-to-face re-evaluation, within the first three months of initiating therapy (but no sooner than the 31st day), which documents both improvement in subjective symptoms of obstructive sleep apnea and objective data related to adherence to PAP therapy.
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January 17, 2011
Question:
What if a counseling session for tobacco cessation only lasts for a few minutes? What code would be assigned?
Answer:
Counseling sessions lasting 3 minutes or less in duration do not meet the intent of codes 99406–99407 and G0436–G0437. The cost associated with a minimal visit (defined as three minutes or less in duration) is considered to be covered as part of each evaluation and management visit billed by the practitioner and is not separately billable. In the hospital setting, respiratory therapy departments should bundle the cost of a minimal visit to the other services provided on the same date of service.