Maximize revenue while avoiding risky practices with this unique resource as your guide
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 noncompliant 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.
Features and Benefits
Updated and expanded content, including:
- Explanation of new, deleted, and revised CPT®/HCPCS codes
- Guidance with all RT-specific HCPCS code changes and National Correct Coding Initiative (NCCI) updates
- Comprehensive information including clarification of supervision requirements for pulmonary rehab, an audit topic that poses serious consequences for noncompliance
- Billing tips and expanded guidance for common problem areas such as inhalation treatments and ventilation management, including coding guidelines and clarification of confusing NCCI rules
- FAQ section addressing some commonly asked questions and challenges observed by our experts across the country
- Special guidance with services that should not be reported, such as evaluation and management (E&M) and recreational therapy, as well as testing provided per protocol —this is a growing area of noncompliance for RT departments that focus on counting productivity
Our experts address common questions, concerns, and problem areas:
- High-risk practices inherent with polysomnography and other sleep studies, such as insufficient prior authorization and incorrect coding for home sleep study tests
- Billing issues with breathing treatments — a prime RAC target — and billing sequence or date of service
- Unbundling of codes and groups of CPT/HCPCS codes that are inappropriately reported together
- Incorrectly billing for routine monitoring, oxygen and services not specifically ordered by a physician
- Medicare medical necessity coverage policies and frequency limitations
- Lack of documentation to support medical necessity
Clear, step-by-step guidance through the tasks you perform every day:
- Coding, documentation and billing for a full range of respiratory therapy services and pulmonary function testing, plus polysomnography and other sleep studies, EEGs, home sleep testing and penile studies
- Covers code assignments by both hospital (technical) and physician (professional) entities
A proven quick-reference approach for busy professionals:
- Easy to navigate; each section contains:
- Descriptions and intended uses of services provided
- Listings of the corresponding CPT/HCPCS and revenue codes, along with explanations of intended code usage
- Modifier usage, where appropriate
- Documentation and medical necessity requirements
- Billing tips
- Clinical examples
- Complete and current payment information, including:
- Hospital Outpatient Prospective Payment System (OPPS) rates
- Procedures with APCs, status indicators and at-a-glance tables showing CPT/HCPCS codes included in APCs, plus prior year and current payment rates
- National and local coverage determinations (LCDs/NCDs)
- Advance beneficiary notices (ABNs)
- NCCI, including procedure-to-procedure (PTP) and Medically Unlikely Edits (MUEs)
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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