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Nitric Oxide use/billing/coverage in Pediatrics OFC for minor surgical procedure

Tina Posted Mon 15th of October, 2012 12:57:58 PM

Our pediatrician had a discussion with our newly hired ARNP who has worked at a children's hospital regarding the use of Nitric oxide on children who need blood draws, I&D of abcesses, etc and have extreme fear of such to calm them. She advised our Doc that they do this commonly- I wonder if this is common? Is it covered by health insurance's? Would it be something you would bill on a non-covered basis? I tried to ask our expert with the AAP but they state it is not a billable service and would be inclusive to the procedure? What would be the CPT codes? How would you bill? Any advice?

SuperCoder Answered Mon 15th of October, 2012 23:53:40 PM

Although a CPT code was introduced in 2007, code 95012 (“nitric oxide expired gas determination for measurement of exhaled nitric oxide (NO)”), payor resistance is still common, and some insurance carriers continue to refuse reimbursement for FENO testing on the grounds that it is investigational, experimental or unproven. However, the consensus panel disagrees with this stand, and believes that the data support the use of FENO in asthma management in conjunction with conventional tools. In many cases, the refusal for payment has been based on studies that failed to demonstrate improved outcomes in asthma management, without acknowledgement of other clinical utilities supported by the literature and clinical experience.

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