Pulmonology Coding Alert

If your practice has held back on pulmonary rehabilitation services due to reimbursement restrictions, next year may bring a whole new set of services and codes to the table.

What's new: HR 6331, the Medicare Improvements for Patients and Providers Act of 2008, established a specific Medicare benefit for pulmonary rehabilitation, which is slated to take effect nationwide on Jan. 1, 2010.

This change spells the end of a lengthy battle for PR's benefits, especially for chronic obstructive pulmonary disease (COPD) patients. Currently, local PR policies vary by jurisdiction and some local coverage  determinations have even revoked PR coverage.

"Until now, there is no question that a lack of a national coverage determination (NCD) hampers the delivery of PR, principally because of the lack of consistency in reimbursement," says Alan L. Plummer, MD, professor of medicine, division of pulmonary, allergy, and critical care at Emory University School of Medicine in Atlanta. "We have tried to get Emory University Hospital to set up and run a full service PR program, but [so far] they have refused due to the lack of sufficient reimbursement to cover the costs."

If your Medicare Administrative Contractor (MAC) already covers PR, the NCD may look familiar to you.

CMS will not have to create the PR benefit "from scratch" because components or services that comprise PR programs are already covered under Medicare. CMS will likely use the local policies as templates in establishing the new PR benefit rules, notes a recent pulmonary rehabilitation bulletin on the American Association for Respiratory Care's Web site.

The NCD will not only render PR a more feasible choice for providers, but consistent reimbursement will also allow patients to receive a necessary service, says Lana Hilling, CRT, RCP, coordinator of lung health services at John Muir Health System in California.

Still, many aren't counting their chickens before they're hatched -- it still remains to be seen what the codes will describe and their associated dollar amounts, Hilling says.