EM Coding Alert

Question: I’m new to pulmonology coding, and I have an encounter note for a recent evaluation and management (E/M) visit. The pulmonologist saw an established patient for continuous positive airway pressure (CPAP) management and chronic obstructive pulmonary disease (COPD) with prescription drug management.

Can we bill 94660 and 99213 together?

Texas Subscriber

Answer: No, you’ll report only 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.) for this encounter.

Here’s why: The CPAP management code, 94660 (Continuous positive airway pressure ventilation (CPAP), initiation and management), is bundled into E/M services according to the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edit pairs. Code 94660 is a column 2 code for 99213 and NCCI lists “0” as the modifier indicator, which means Medicare will not allow you to override the edit and report the two codes separately.