Challenges will strike in 2025 whether you are prepared or not. Don’t underestimate problems that could cost both time, resources, and money while threatening compliance.
Maximize revenue while ensuring compliance and avoiding risky practices with the Coding Essentials for Respiratory Therapy and Pulmonary Function book. This invaluable resource provides step-by-step guidance, expert insights, and updated content to help you navigate the complex world of coding, billing, and documentation for respiratory therapy services, pulmonary function testing, and sleep study services.
Key Features and Benefits:
- Comprehensive information: The book covers a wide range of topics, including supervision requirements for pulmonary rehab, billing tips, and expanded guidance for common problem areas like inhalation treatments and ventilation management. It also addresses frequently asked questions and challenges observed by experts across the country.
- Specialized guidance: Learn about services that should not be reported, such as evaluation and management (E&M) and recreational therapy. This resource sheds light on testing provided per protocol, which is an area of growing noncompliance for RT departments focused on productivity.
- Compliance-focused guidance: Our trusted RT experts address potential pitfalls and non-compliant practices, such as insufficient documentation, unbundled coding, modifier misuse, and inappropriate coding of services. You’ll gain the knowledge and tools to protect your compliance and revenue.
- Addressing common concerns: High-risk practices associated with polysomnography and sleep studies, billing issues with breathing treatments, unbundling of codes, incorrect billing for routine monitoring and oxygen, Medicare medical necessity coverage policies, and lack of documentation are among the topics covered by our experts.
- Step-by-step guidance: Navigate daily tasks with ease. The book provides clear instructions for coding, documentation, and billing for a full range of respiratory therapy services, pulmonary function testing, sleep studies, EEGs, home sleep testing, and penile studies. It covers both hospital (technical) and physician (professional) code assignments.
- Quick-reference format: Designed for busy professionals, the book features an easy-to-navigate layout. Each section includes descriptions and intended uses of services, corresponding CPT/HCPCS and revenue codes, modifier usage, documentation requirements, billing tips, and clinical examples. Stay informed with complete and current payment information, including OPPS rates, APCs, national and local coverage determinations, and NCCI guidelines.
Maximize your revenue while ensuring compliance in respiratory therapy and pulmonary function coding. Get your copy of the Coding Essentials for Respiratory Therapy and Pulmonary Function book today and gain the knowledge and confidence to navigate this challenging area of healthcare effectively.
Facilities strive to maximize revenue, but, with respiratory therapy services, it’s also about avoiding risky practices — because auditors, regulators and payers are watching closely! This unique resource will guide you through charge capture and coding while helping you avoid non-compliant practices for a full range of respiratory therapy, pulmonary function testing and sleep study services.
Count on our trusted RT experts to guide you step by step through the intricacies of coding, charging, billing and documentation for this very challenging area of healthcare. Along the way, you’ll discover a wealth of dos and don’ts, equipping you to protect your compliance and revenue. We address many potential pitfalls, including insufficient documentation, unbundled coding, modifier misuse and the inappropriate coding of services.
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Introduction
Chapter 1: Medicare Payment Methods For Respiratory Therapy Services
- Inpatient Services
- Outpatient Services
- Evaluation and Management Services
Chapter 2: Coding & Billing for Correct Reimbursement
- Overview of Chargemaster Billing Codes
- Healthcare Common Procedural Coding System
- CPT Usage and Format
- Modifiers
- Modifier Guidelines
- Revenue Codes
- APC Status Indicators: A Guide to Outpatient Reimbursement
- National Correct Coding Initiative and Modifier Application
- What is the NCCI?
- Procedure-to-Procedure Edits
- Column 1 and Column 2 Codes (CC)
- Medically Unlikely Edits (MUEs)
- The ICD-10 Coding System
- Stay Informed
- Chargemaster Review Methods
- Gathering Necessary Materials
- The Chargemaster Review Process
- Value-Based Purchasing
Chapter 3: Coding & Billing Strategies
- Diagnostic Testing (Pulmonary Function Testing)
- General Limitations of Pulmonary Function Studies
- Documentation Requirements
- Documenting the Exacerbations of Asthma
- Incentive Spirometry, Peak Flow, and Bronchial Hygiene Procedures
- Spirometry (94010)
- Spirometry for Infant or Child (94011–94013)
- Patient Initiated Spirometric Recording (94014–94016)
- Bronchospasm Evaluation (94060, 94070)
- Vital Capacity (94150)
- Maximum Breathing Capacity, Maximal Voluntary Ventilation (94200)
- Respiratory Flow Volume Loop (94375)
- Breathing Response to Hypoxia (94450)
- High Altitude Simulation Testing (94452–94453)
- Pulmonary Stress and Exercise Testing (94617–94621)
- Oxygen Uptake (94680–94690)
- Plethysmography (94726)
- Lung Volumes (94727)
- Airway Resistance Impulse Oscillometry (IOS) (94728)
- Diffusing Capacity (94729)
- Pulse Oximetry (94760–94762)
- Pediatric Pneumogram (94772)
- Apnea Monitoring (94774–94777)
- Car Seat/Bed Testing (94780–94781)
Chapter 4: Respiratory Therapy and Treatments
- Ventilation Assist and Management (94002–94005)
- Intrapulmonary Surfactant Administration (94610)
- Pressurized or Nonpressurized Inhalation Treatments (94640)
- Continuous Inhalation Treatment (94644, 94645)
- Continuous Positive Airway Pressure (CPAP) (94660)
- Continuous Negative Airway Pressure (CNP) (94662)
- Evaluation and Demonstration (94664)
- Manipulation of Chest Wall, Manual, Initial and Subsequent (94667–94668)
- Manipulation of Chest Wall, Mechanical (94669)
Chapter 5: Other Services
- Bronchoscopy Procedures (31622–31661)
- Specimen Collection (36415, 36591, 36592, 36600, 89220)
- Arterial Blood Gases (82800–82810)
- Transcutaneous Procedures (88740–88741)
- Cardiopulmonary Resuscitation (92950)
- Breathing and Coughing Exercises
- Oxygen Therapy
- Supplies, Services, and Equipment Considered Part of Administrative Costs
Chapter 6: Pulmonary Rehabilitation and Tobacco Counseling Services
- Pulmonary Rehabilitation (94625–94626)
- Respiratory Rehabilitation Services (G0237–G0239)
- Smoking Cessation and Tobacco Counseling Services (99406–99407)
Chapter 7: Remote Monitoring
- Remote Physiologic Monitoring (RPM) (99453–99454)
- Remote Therapeutic Monitoring (RTM) (98975–98976, 98980–98981)
Chapter 8: Sleep Studies
- Sleep Testing
- Actigraphy (95803)
- Multiple Sleep Latency Test (MSLT) (95805)
- Sleep Studies (95800, 95801, 95806, 95807)
- Polysomnography (95782–95811)
- Penile Study (54250)
- Home Sleep Testing (G0398–G0400)
- Electroencephalogram (95812–95822, 95705–95718)
- Documentation Requirements For Sleep Studies
Appendix A: Local Coverage Determinations
Appendix B: National Coverage Determinations
- Smoking and Tobacco-Use Cessation Counseling
- 240—Respiratory System
Appendix C: 2022 APC Payment Rates
Appendix D: Medicare Guidelines
- Medicare Benefit Policy Manual
- Medicare Claims Processing Manual
Appendix E: Pulmonary Rehabilitation Toolkit
Appendix F: Guidelines for Managing Asthma Exacerbations
- Formal Evaluation of Asthma Exacerbation Severity in the Urgent or Emergency Care Setting
- Management of Asthma Exacerbations: Home Treatment
- Management of Asthma Exacerbations: Emergency Department and Hospital-Based Care
Appendix G: Recovery Audit Program
Appendix H: Office of Inspector General Report: Mechanical Ventilation
Appendix I: Frequently Asked Questions
Appendix J: Office of Inspector General Report: Cardiac and Pulmonary Rehabilitation
