Kelly Posted Tue 24th of October, 2017 18:18:40 PM
In an Emergency Department setting, for facility billing, is it appropriate to charge CPT 94644x1,and 94645x1, when the documentation states breaks were taken? The documentation specifically says, "a run time from "1428-1600, for continuous treatment with breaks taken to try to calm patient as patient fought burst throughout..." but the break times were not documented and per the Respiratory Therapist, this is a one hour treatment that took longer due to the need for a pediatric patient to have breaks. Is this really a continuous treatment? How should this scenario be charged/billed to the patient?
SuperCoder Answered Wed 25th of October, 2017 02:01:07 AM
Codes 94644x1 and 94645x1 can be reported. Since both are are time-based codes, the documentation should clearly indicate treatment start/stop times, as well as total duration. Also, it is suggested to check the payer preference once, before going ahead with the final billing. Thank you.
Kelly Posted Wed 25th of October, 2017 14:56:16 PM
As mentioned, the amount of break time taken is not documented, so how should this be charged?
SuperCoder Answered Fri 27th of October, 2017 07:39:47 AM
Hi, these codes would be appropriate in the given scenario, considering the run time that is documented for continuous treatment. Though the documentation says that breaks were taken, but since the patient was not discharged, it will be considered continuous.
These codes have no physician work value but have practice expense value which reflects the costs of maintaining a practice, such as office space rent, supplies and equipment, and staff cost.