Compliance Question of the Week – Respiratory

Is a face-to-face clinical evaluation required for a sleep study?

What are the billing requirements for pulmonary rehabilitation (PR) codes 94625 and 94626?

When should RPM codes 99453 and 99454 not be reported?

From a billing perspective, under what circumstances may code +98981 be reported in conjunction with code 98980? What specific requirements regarding the duration and type of communication must be met, and what documentation practices are necessary to support these charges?

What are the key monitoring and intervention protocols during a split study polysomnography (PSG) for patients with suspected sleep apnea?

How do you bill for intrapulmonary percussive ventilation (IPV)?

How do the NCCI procedure-to-procedure edits impact the reimbursement and billing process for services involving CPT codes 94640 and 94644/+94645 when performed on the same day?

As of 2024, what is code 94727 used to evaluate?

What is the significance of using the term “first hour” in CPT code 94644, and how does this differ from other time-based codes that use the term “up to 1 hour”?

When should code 95813 be reported during a sleep study, and what is the duration of monitoring that qualifies for this code?

What is the typical duration of a polysomnography (PSG) procedure as described by codes 95810 and 95811?

How does the presence of unit of service edits and medically unlikely edits impact the billing practices for code 94375, particularly regarding the flow volume loop as an alternate method of calculating standard spirometric parameters, and what considerations should healthcare providers keep in mind to ensure proper reimbursement while adhering to CMS guidelines?