Neurology & Pain Management Coding Alert

Question: A patient had a sleep study done and came to our office afterwards. The neurologist prescribed a CPAP. Can we charge separately for the CPAP (94660) or is it included in the E/M? 

Pennsylvania Subscriber

Answer: Before you can bill for 94660 (Continuous positive airway pressure ventilation [CPAP], initiation and management), the physician must provide a face-to-face encounter with the patient. Since this is not a time-based service, it doesn’t require physician presence in the room throughout the entire time the patient is in the office. However, it is not an “incident-to” service, which means you cannot report it when another health care provider performs it. 

You should use 94660 for the initiation and management of CPAP therapy. You bill this code when the treatment is initiated with the patient, in order to describe the initiation and instruction of the patient. If the patient returns and requires additional instruction on use or other issues related to the use of the CPAP device, you should report this service once again.

Exception: If, on those occasions, a separately identifiable service occurs (i.e., the physician does not spend the visit solely for management of the patient’s use of the CPAP machine), then you should bill either a level of office visit or 94660, whichever involves the most time and focus of the visit. You cannot bill 94660 with E/M services because of CCI (Correct Coding Initiative) edits.

Another option: According to CPT® Assistant from October 2014, you can sometimes choose to report an E/M code instead of 94660, if your physician is addressing other issues or diagnoses in addition to sleep apnea during the encounter. Even if you’re only instructing the patient on CPAP initiation, an E/M code could be appropriate to select. 

Careful: Do not ever bill 94660 on a routine basis, such as monthly or even quarterly. Report the code when only when the patient’s need warrants it. If the service is provided to a Medicare beneficiary by a non-physician provider in the physician’s office, report 94660 under the NPP’s name (as permitted by the State Scope of Practice).