Compliance Question of the Week – Respiratory

When a diagnostic or surgical endoscopy of the respiratory system is performed and an evaluation of the access regions is performed, can the evaluation be reported separately?

What revenue codes may be used for respiratory therapy codes?

How many times does Medicare allow CPT® code 94664 to be reported for demonstrating a nebulizer to a patient?

Can an evaluation and management (E&M) code be reported when a physician in attendance for pulmonary diagnostic testing or therapy obtains a limited history and performs a limited physical examination?

One of our patients presented with nasal obstruction, sinus obstruction, and multiple nasal polyps, and we performed a biopsy in conjunction with polypectomy and ethmoidectomy. Can we report a separate biopsy code for this?

Can 31645 be billed when the doctor dictates that “mucous secretions were suctioned out of the lower left lobe”? Does it have to be an abscess or mucous plug that was removed in order to use this code?

To report the PSG codes, is there a certain number of hours that sleep must be recorded?

What code is reported for aspiration/drainage procedures?

What code do we use to bill Medicare for demonstration of a nebulizer or inhaler device or for demonstrating chest-percussion techniques?

An outpatient lung cancer patient on a ventilator is receiving intermittent breathing nebulizer treatments (94640) and is also receiving Milrinone via continuous inhalation treatment with aerogen generator. The patient receives the continuous Milrinone 24 hrs/day x 5 days. The Milrinone runs for six hours and then is changed out with new pre-loaded syringe.
Is the continuous inhalation treatment; first hour 94644, billed on the first day of the five-day run, billed once per day for the 5 days, or billed each time the continuous treatment is changed out (every 6 hours)? The answer to the above question will then answer how to bill 94645 continuous inhalation treatment; each additional hour.

We assign code 94375 (respiratory flow volume loop) when a preoperative evaluation is ordered to distinguish between fixed and variable upper-airway obstructions. Can you provide any billing guideline we should know?

Can respiratory therapists (RTs) perform smoking and tobacco-use cessation counseling services for Medicare patients? Since the RTs really don’t submit claims, can the hospital bill a technical component if the services are performed by an RT under physician order (i.e., under the Medicare incident-to policy)?