Pulmonology Coding Alert

Which HCPCS code expired this year? Find out.

Patients who have recovered from a COVID-19 infection may still experience persistent symptoms related to the disease. Post-COVID symptoms can negatively affect the patient’s quality of life, but with pulmonary rehabilitation, patients can return to their favorite activities.

Learn how to code pulmonary rehabilitation for patients with post-COVID symptoms.

What Is Pulmonary Rehabilitation?

Pulmonary rehabilitation (PR) is an outpatient treatment program that combines education with exercises to help patients recover from or alleviate the symptoms of lung diseases. “[PR] is tailored to a patient’s specific needs and addresses the physical, psychological, and lifestyle-impacting aspects of a disease,” says Georges Debal, MD, of Parkview Physicians Group in Fort Wayne, Indiana (URL: www.parkview.com/community/dashboard/the-importance-of-pulmonary-rehab-for-covid-19-patients). Until 2019, most PR patients suffered from common lung diseases, such as chronic obstructive pulmonary disease (COPD) or pulmonary fibrosis, but in the past two years, patients with post-COVID conditions are more frequent PR candidates.

Why? A post-COVID patient suffering from shortness of breath had their condition onset rapidly, whereas a patient with COPD (J44.0-J44.9 Chronic obstructive pulmonary disease …) experiences a similar symptom progressively.

According to the Centers for Disease Control and Prevention (CDC), post-COVID conditions are a “range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes COVID-19” (URL: www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html). Symptoms, such as fatigue, shortness of breath, cough, chest or stomach pain, headaches, and fever can persist for weeks or months after the first infection, and patients experiencing persistent post-COVID symptoms are at risk of permanently damaging their pulmonary systems.

However, if the patient begins pulmonary rehabilitation around the fourth week after the symptoms appear, they’ll experience greater benefits rather than waiting until the symptoms subside. 

Why? A post-COVID patient suffering from shortness of breath had their condition onset rapidly, whereas a patient with COPD (J44.0-J44.9 Chronic obstructive pulmonary disease …) experiences a similar symptom progressively.

According to the Centers for Disease Control and Prevention (CDC), post-COVID conditions are a “range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes COVID-19” (URL: www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html). Symptoms, such as fatigue, shortness of breath, cough, chest or stomach pain, headaches, and fever can persist for weeks or months after the first infection, and patients experiencing persistent post-COVID symptoms are at risk of permanently damaging their pulmonary systems.

However, if the patient begins pulmonary rehabilitation around the fourth week after the symptoms appear, they’ll experience greater benefits rather than waiting until the symptoms subside.

Revitalize Your PR Coding Skills

Scenario: A patient visits your pulmonology practice with a referral from their general practitioner (GP). The patient received a positive COVID-19 diagnosis four weeks earlier and is still experiencing shortness of breath and fatigue when doing day-to-day activities. Their physician diagnosed them with pulmonary fibrosis as well, but they no longer have COVID-19 and have tested negative on two PCR tests, coded as 87635 (Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique). Their GP referred them to a pulmonologist for a pulmonary rehabilitation consultation. After the pulmonologist meets with the patient and assesses their condition, the physician recommends PR three times a week for eight weeks.

For this scenario, you’ll assign Z71.82 (Exercise counseling) to the encounter for the PR consultation. The patient is visiting your outpatient facility due to the lingering effects of a COVID-19 infection, so you’ll need to assign U09.9 (Post COVID-19 condition, unspecified) to establish a link to COVID-19. You should only assign U09.9 to patients who no longer have an active COVID-19 infection.

Code first note: Code U09.9 features a Code first note for you to use an appropriate condition code that’s related to COVID-19, if the condition is known. The specific conditions listed in the Code first note include:

• J96.1- (Chronic respiratory failure)
• R43.8 (Other disturbances of smell and taste), which includes loss of smell and loss of taste
• M35.81 (Multisystem inflammatory syndrome)
• I26.- (Pulmonary embolism)
• J84.10 (Pulmonary fibrosis, unspecified)

In this scenario, the patient is diagnosed with pulmonary fibrosis, so you’ll assign J84.10 before U09.9 to link the two conditions together.

Does CPT^® code 4033F apply? Even though the pulmonologist recommended PR, you won’t use CPT^® code 4033F (Pulmonary rehabilitation exercise training recommended (COPD)) for this scenario, as the code “is a performance measure that applies to COPD patients. The code does not translate to all illnesses,” says Carol Pohlig, BSN, RN, CPC, and manager, Coding & Education in the Department of Medicine at the Hospital of the University of Pennsylvania in Philadelphia.

However, as the patient begins PR, you’ll assign a code to each rehabilitation session. You’ll use 94625 (Physician or other qualified health care professional services for outpatient pulmonary rehabilitation; without continuous oximetry monitoring (per session)) or 94626 (…; with continuous oximetry monitoring (per session)) since HCPCS code G0424 (Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day) expired on Jan. 1, 2022. “[HCPCS code] G0424 was allowed to be reported one hour per session, with up to two sessions per day,” Pohlig says. Another HCPCS code, S9473 (Pulmonary rehabilitation program, non-physician provider, per diem), can be assigned for PR as well. However, “S9473 is payment, typically to the facility, for services of the nonphysician provider — it’s a per diem code.”

Receive Reimbursement for PR Care

Medicare covers a patient’s post-COVID PR thanks to the calendar year (CY) 2022 Medicare Physician Fee Schedule (MPFS) final rule. In the final rule, the Centers for Medicare & Medicaid Services (CMS) provides coverage for beneficiaries “who have had confirmed or suspected COVID-19 and experience persistent symptoms that include respiratory dysfunction for at least four weeks.” This coverage allows patients to receive care for recovery without fear of high out-of-pocket costs, as well as ensuring your practice collects reimbursement for the care delivered.