Neurology & Pain Management Coding Alert

Question: When I interpret sleep studies (CPAP), I have to reprogram or interrogate the machine when the patient returns for follow-up. Is there a code for this other than a follow-up evaluation and management visit?


Georgia Subscriber

Answer: Code 99090 (Analysis of clinical data stored in computers [e.g., ECGs, blood pressures, hematologic data]) can be used to indicate the interpretation of data from the continuous positive airway pressure (CPAP) testing device, while 99091 (Collection and interpretation of physiologic data digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional, requiring a minimum of 30 minutes of time) designates both collection and analysis.

Beware: Most payers, including Medicare, include 99090 and 99091 in E/M services, so if you are also performing follow-up care, you should consider other options.

Instead: Let relative value units (RVUs) serve as your guide in opting for general E/M codes 99212-99214 or the more specific 94660 (Continuous positive airway pressure [CPAP] ventilation, initiation and management).

When performing the service in-office, the CPAP management code carries 1.45 RVUs or a national average of $54.95. Unless your physician can document two of three criteria--detailed history, detailed exam, and medical decision-making of moderate complexity--to justify an E/M of at least 99214 (2.18 RVUs for $82.65), 94660 will capture more reimbursement for the CPAP follow-up.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.