Respiratory Question for the Week of February 13, 2017

Question:

Is code 94680 (oxygen uptake) included in a cardiopulmonary exercise test performed to assess chronic obstructive pulmonary disease? If so, how should it be billed?

Answer:

Yes, code 94680 may be included in a comprehensive cardiopulmonary exercise test to assess disability and, according to research studies, oxygen uptake measurements may be indicated in patients with sepsis, chronic obstructive lung disease, sleep apnea and other cardiopulmonary diseases.

Depending on the method used, the result (VO2) may be obtained by direct measure or calculation. Calculated test results are not to 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 NCCI indicates that the oxygen uptake is never separately billable by associating a modifier indicator of “0” with the code pair.

Check with the Medicare payer to determine coverage for your facility.