http://www.supercoder.com/forum/ Supercoder - Ask an Expert? Forum: Pulmonology Coding - Recent Posts en Sun, 12 Feb 2012 12:04:20 +0000 http://www.supercoder.com/forum/topic/pulmonary#post-11331 Fri, 10 Feb 2012 18:31:45 +0000 Sue Baker 11331@http://www.supercoder.com/forum/ <p>Our doctor bills for a 99214-25, 94640 and 94060. Medicare says that 94640 bundles with 94060 but a modifier may be used to unbundle the code for reimbursement. Do you know what modifier I would attach to 94640? </p> http://www.supercoder.com/forum/topic/sleep-study-plus-oxygen#post-11325 Fri, 10 Feb 2012 16:26:15 +0000 Sanjit Mishra 11325@http://www.supercoder.com/forum/ <p>In the context, it may seem not to separately bill for oxygen as it is part of the Sleep Study. But, if the following conditions are complied with, I think we can bill for the Oxygen:<br /> You can bill for Oxygen when there is a written order for the oxygen. “Oxygen PRN” is not satisfactory for Medicare reimbursement. The physician’s order must state the oxygen device and/or the specific flow rate or concentration of oxygen desired. A prescription for “oxygen PRN” or “oxygen as needed” does not meet these requirements. An intermittent or PRN oxygen therapy order must include time limits and specific indications for initiating and terminating therapy.<br /> *<br /> If the Medicare contractor notes the use of continuous oxygen without periodic assessment of arterial PO2, it may request additional documentation to determine the medical necessity for the service.<br /> *<br /> There is no CPT code for oxygen, and hospitals should not bill for oxygen using the unlisted CPT code 94799. Hospitals should bill it with the revenue code 0271, designating it as a supply. It must be billed in “measurable” units, such as per liter, per hour, per quarter hour, per minute. </p> http://www.supercoder.com/forum/topic/sleep-study-plus-oxygen#post-11286 Thu, 09 Feb 2012 15:11:44 +0000 yides fuchs 11286@http://www.supercoder.com/forum/ <p>I wonder if you can help me with this Question- -A Patient had to have Oxygen during a Sleep Study can the provider bill for the Oxygen? and if yes which code? </p> http://www.supercoder.com/forum/topic/can-a-provider-bill-for-31622-twice-in-the-same-24-hour-period#post-11073 Wed, 01 Feb 2012 00:17:37 +0000 Dena Hadley 11073@http://www.supercoder.com/forum/ <p>We have billed this code twice in the same day with a 76 modifier and chart notes. It is extremely rare but it has happened. </p> http://www.supercoder.com/forum/topic/94729-1#post-11072 Wed, 01 Feb 2012 00:16:03 +0000 Dena Hadley 11072@http://www.supercoder.com/forum/ <p>For hospital readings we bill 94726, 94729 and either 94375 or 94060 all with a 26 mod. We are getting paid. The only time they should come back as not valid would be if the dos was in 2011. Hope that helps. </p> http://www.supercoder.com/forum/topic/pft-coding-2012#post-11071 Tue, 31 Jan 2012 23:36:46 +0000 Dena Hadley 11071@http://www.supercoder.com/forum/ <p>Yes we have. We started using them January 1st. We first made the mistake of billing the 94726 and 94727. We couldn't get those to pay together. This combination seems to pay and our doctors feel is it appropriate for the services rendered. </p> http://www.supercoder.com/forum/topic/pft-coding-2012#post-11063 Tue, 31 Jan 2012 20:44:48 +0000 Deborah Landon 11063@http://www.supercoder.com/forum/ <p>Dena: Have you been paid for using the above codes??? </p> http://www.supercoder.com/forum/topic/pft-coding-2012#post-11057 Tue, 31 Jan 2012 19:24:04 +0000 Dena Hadley 11057@http://www.supercoder.com/forum/ <p>We use 94060, 94726, 94729. We also use 85018. We use no modifiers. </p> http://www.supercoder.com/forum/topic/94729-1#post-11017 Mon, 30 Jan 2012 20:49:19 +0000 Deborah Landon 11017@http://www.supercoder.com/forum/ <p>We perform pulmonary function tests in the office and my doctor also interprets these tests at the hospital I bill for the interpretation of the tests done in the hospital. I also bill for the actual test and inter done here in the office. I am billing 94060 with 26 modified, 94729 with 26 modified and 94726 with 26 modifier for hospital charges. There are being returned because 94729 and 94726 are invalid codes codes. But I have already billed 94722, 94720 and 94350 and they were returned because of invalid codes. We are getting the same denials when these tests are performed in the office. What are the correct codes for Plethysmography, lung volumes and Diffusion capacity???? </p> http://www.supercoder.com/forum/topic/94729-1#post-11012 Mon, 30 Jan 2012 19:56:35 +0000 Donna Christian 11012@http://www.supercoder.com/forum/ <p>Should we bill an E/M, if appropriate, instead of 94729, if the provider only does the diffuse capacity? If the provider only does the diffuse capacity, do we use our no charge visit? Our pulmonoligst is doing CPT 94729 as the only service for some of her patients. Thank you! </p> http://www.supercoder.com/forum/topic/can-a-provider-bill-for-31622-twice-in-the-same-24-hour-period#post-10965 Sat, 28 Jan 2012 20:46:50 +0000 Sanjit Mishra 10965@http://www.supercoder.com/forum/ <p>31622 has a Medically Unlikely Edit number of 1, meaning it should only be billed once per day.</p> <p>Now, you need to bypass the edits to bill it twice on same DOS,and for that you should be able to bypass edits with justification as per bypassing guidelines mentioned below.<br /> *<br /> BYPASSING MUE EDITS:<br /> CMS has provided guidance that MUEs are to be adjudicated separately against each line on a claim rather than the entire claim. This process is triggered by appending an appropriate modifier to more than one line on a claim reporting the same CPT code. CPT modifiers such as 76 (repeat procedure by same physician), 91 (repeat clinical diagnostic laboratory test), and 59 (distinct procedural service) will accomplish this purpose. However, providers should be aware that modifier 59 is the modifier of last resort and should only be used if no other modifier describes the service. </p> http://www.supercoder.com/forum/topic/pulmonary-pt#post-10823 Wed, 25 Jan 2012 14:16:46 +0000 Annette Taylor 10823@http://www.supercoder.com/forum/ <p>Spoke with the nurse was told that it is not a surgical prodecure and is aware of the risk assessment of MDM. Just need the correct E/M code to get the patient admitted into the hospital. </p> http://www.supercoder.com/forum/topic/pulmonary-pt#post-10819 Wed, 25 Jan 2012 05:20:07 +0000 Sanjit Mishra 10819@http://www.supercoder.com/forum/ <p>Can you elaborate if the entire session is a surgical procedure or an E/M assessment or both?<br /> Plz keep in mind that "Decision not to resuscitate or to de-escalate care or to de-escalate care because of poor prognosis" falls in HIGH risk category in Risk assessment of MDM in an E/M. </p> http://www.supercoder.com/forum/topic/pulmonary-pt#post-10787 Tue, 24 Jan 2012 16:49:32 +0000 Annette Taylor 10787@http://www.supercoder.com/forum/ <p>We have a pulmonary pt that has a trach but the doctor has decided to remove the trach and let the patient die. The term that the nurses are using is Decannulation or De-escalation of care for the patient and went to know what cpt code we could use to code this. </p> http://www.supercoder.com/forum/topic/can-a-provider-bill-for-31622-twice-in-the-same-24-hour-period#post-10772 Tue, 24 Jan 2012 01:56:38 +0000 robin yaeger 10772@http://www.supercoder.com/forum/ <p>ONe of the doctors in our practice is insisting on billing for a 31622 done two times in the same day. how can we do this </p> http://www.supercoder.com/forum/topic/pulmonary-codes#post-10759 Mon, 23 Jan 2012 20:38:30 +0000 Sanjit Mishra 10759@http://www.supercoder.com/forum/ <p>CCI Edits also include a scenario when a CPT although included in the another procedure completely should not be billed with the other CPT, but if there are some exceptional scenarios where these two codes can be billed together, then it allow both codes to be coded together with a modifier 59 for the inclusive code.<br /> This code combination is of a rare scenario where can they can be billed together with a modifier, but by concept these two codes usually not billed together in most of the circumstances. </p> http://www.supercoder.com/forum/topic/pft-coding-2012#post-10725 Mon, 23 Jan 2012 12:05:16 +0000 Sanjit Mishra 10725@http://www.supercoder.com/forum/ <p>Complete PFT pre &amp; post bronchodilator: CPT 94726,94727-59,94010-51,94664-51 </p> http://www.supercoder.com/forum/topic/pft-coding-2012#post-10723 Mon, 23 Jan 2012 03:22:02 +0000 Faisal Fakih 10723@http://www.supercoder.com/forum/ <p>what codes should be used for complete pft with bronchodilators? We have a body box with our pft machine, so i want to receive the correct reimbursement. </p> http://www.supercoder.com/forum/topic/code-for-respiratory-failure#post-10709 Fri, 20 Jan 2012 18:05:52 +0000 Sanjit Mishra 10709@http://www.supercoder.com/forum/ <p>519.19 for tracheal stenosi<br /> 519.02 for Tracheal stenosis due to tracheostomy</p> <p>*<br /> 518.81 for Acute respiratory failure<br /> 518.83 for Chronic respiratory failure<br /> 518.84 for Acute and chronic respiratory failure<br /> *<br /> 518.51 for Acute respiratory failure following trauma and surgery<br /> 518.53 for Acute and chronic respiratory failure following trauma and surgery </p> http://www.supercoder.com/forum/topic/code-for-respiratory-failure#post-10708 Fri, 20 Jan 2012 17:32:54 +0000 imran haq 10708@http://www.supercoder.com/forum/ <p>code for tracheal stenosis and respiratory failure please? </p> http://www.supercoder.com/forum/topic/what-codes-should-i-use-to-bill-a-flu-shot-and-pneumonia-shot-to-blue-cross#post-10692 Thu, 19 Jan 2012 23:03:15 +0000 Carolyn Carroll 10692@http://www.supercoder.com/forum/ <p>Why aren't you billing the vaccine administration codes to Blue cross? 90471 and 90472 The Q and the G codes are for medicare we bill all other payers with CPT codes not HCPCs. </p> http://www.supercoder.com/forum/topic/what-codes-should-i-use-to-bill-a-flu-shot-and-pneumonia-shot-to-blue-cross#post-10681 Thu, 19 Jan 2012 21:14:18 +0000 Deborah Landon 10681@http://www.supercoder.com/forum/ <p>The flu and pneumonia vaccine are always given at the time of the visit. We bill 99213 for the visit, then Q2038 diagnosis V04.61. Then we bill G0008 with diagnosis of V04.61. For pneumonia we bill 90732 diagnosis V06.6 and then G0009. They will pay for the Q2038 and the 90732, but not for the G codes. They have always paid for them in the past. Medicare pays for them with no problems... And we alwasys check to make sure they have not already had one.. </p> http://www.supercoder.com/forum/topic/albuterolpulmicort-combination#post-10665 Thu, 19 Jan 2012 17:38:19 +0000 Lisa Lott 10665@http://www.supercoder.com/forum/ <p>One of our physicians gave a combination albuterol/pulmicort inhalation treatment. They would like to know if they can bill only 1 code or if they have to bill 2 separate HCPCS codes. I am unsure of what to tell them.<br /> Thank you in advance for your help. </p> http://www.supercoder.com/forum/topic/94729-1#post-10644 Thu, 19 Jan 2012 14:06:34 +0000 Sanjit Mishra 10644@http://www.supercoder.com/forum/ <p>That doesn't comply with Coding Guidelines. CPT 94729 should not be billed without a Primary Procedure. If you are billing this way, and if you are geting payment (as an error from Insurance), then you are likely to face a refund request from Insurance in future at any point of time of all the previoius paid claims.</p> <p>Please find ways and means of documenting the procedures and treatment guidelines for your practice so as to bill 94729 as an "Add-On" code with corresponding "Primary Procedures". </p> http://www.supercoder.com/forum/topic/what-codes-should-i-use-to-bill-a-flu-shot-and-pneumonia-shot-to-blue-cross#post-10615 Wed, 18 Jan 2012 18:08:45 +0000 Sanjit Mishra 10615@http://www.supercoder.com/forum/ <p>Before assuming this, let's I request you check the following:<br /> 1. If the sole purpose for the visit was to receive the influenza virus vaccine or if the influenza virus vaccine is the only service billed on a claim, the provider must report diagnosis code V04.81. However, if the purpose of the visit was to receive both the influenza virus vaccine and the pneumococcal vaccine,Medicare providers must report diagnosis code V06.6.<br /> 2. If BCBS has a certain frequency of coverage(as once per year per Medicare), and the beneficiary requests vaccination more than the coverage during the same time, and the BCBS provider could not justify the medical necessity for the 2nd vaccination, then there will be a denial </p> http://www.supercoder.com/forum/topic/94729-1#post-10606 Wed, 18 Jan 2012 14:52:45 +0000 Gerri Brunow 10606@http://www.supercoder.com/forum/ <p>I know that CPT 94729 is an add-on code and CPT sggests that it is most commonly performed in addition to other procedures and to code first 94010,94060,94070,94375,94726-94728 but, can it reported by itself. We do perform these with nothing else from time to ime?</p> <p>Thanks ! </p> http://www.supercoder.com/forum/topic/cpt-94780-and-94781-clarification#post-10605 Wed, 18 Jan 2012 14:48:03 +0000 Gerri Brunow 10605@http://www.supercoder.com/forum/ <p>Thanks, I agree with you 100%! </p> http://www.supercoder.com/forum/topic/pulmonary-codes#post-10598 Wed, 18 Jan 2012 07:26:41 +0000 Sanjit Mishra 10598@http://www.supercoder.com/forum/ <p>I will suggest not to bill 94727 (with 94626) when performed by same physician in same session and for the same medical necessity. </p> http://www.supercoder.com/forum/topic/cpt-94780-and-94781-clarification#post-10595 Wed, 18 Jan 2012 05:37:27 +0000 Sanjit Mishra 10595@http://www.supercoder.com/forum/ <p>Based on the below lay descriptions, I have doubts if this can only be performed in Office Setting. I don't find any supportive documentation to confirm what you've heard in the Webinar.<br /> Lay Description for 94780:<br /> A hospital professional trained in car seat/bed safety and positioning, as well as monitoring for apnea, bradycardia, and oxygen saturations, observes a newborn patient to ensure that the neonate does not have a cardiac or respiratory event. This type of event occurs most often in preterm or low birth weight infants, infants born with hypotonia (e.g., Down syndrome), or infants who undergo congenital cardiac surgery. The newborn is placed in the car seat/bed at a 45 degree angle with the harness clip at chest level. The infant is attached to a monitor that assesses heart rate, respiratory rate, and oxygen saturation. Obstructive apnea monitoring may be performed as well. The infant is standardly observed for 60 to 120 minutes or the amount of time the baby will be in transport home, whichever is longer..... </p> http://www.supercoder.com/forum/topic/what-codes-should-i-use-to-bill-a-flu-shot-and-pneumonia-shot-to-blue-cross#post-10577 Tue, 17 Jan 2012 19:24:37 +0000 Deborah Landon 10577@http://www.supercoder.com/forum/ <p>Blue Cross does not like G0008 and G0009 </p>