Can you report 94610 with critical care codes? Find out.
Babies who are born prematurely can experience several health issues, including respiratory problems. One treatment method involves pulmonologists administering medication through an endotracheal tube to treat the air sacs within the lungs.
Read on to learn when physicians administer surfactants and how to correctly report the procedure for reimbursement.
Familiarize Yourself With the Intricacies of 94610
The alveoli (air sacs) of the lungs are lined with a lipoprotein complex that helps reduce the surface tension so the lungs won’t collapse. The complex is also known as a pulmonary surfactant; when a patient experiences surfactant deficiency, they may suffer from lung atelectasis. Atelectasis is a total or partial collapse of the lung or lobe in the lung.
Surfactant deficiency is a common cause of respiratory distress syndrome (RDS) in premature newborn infants. To treat RDS, physicians will intubate the patient and administer pulmonary surfactant into the lungs. The drug helps release the alveoli surface tension to allow the lungs to inflate properly.
You’ll assign 94610 (Intrapulmonary surfactant administration by a physician or other qualified health care professional through endotracheal tube) to report the administration of the pulmonary surfactant.
Sift Through the Surfactant Types
Pulmonologists can choose from natural and synthetic surfactants to treat their patients. Natural surfactants are derived from animal sources and feature proteins and phospholipids. Synthetic surfactants are manufactured treatments and don’t contain proteins.
Examples of the two types of surfactants include, but are not limited to:
The procedure code 94610 doesn’t include the specific type of surfactant administered, just the procedure itself. You may be able to report the surfactant separately with an HCPCS Level II code, but this depends on which product is used and your payer’s reporting requirements. Double check with the payer for how it prefers you to report the medication used.
Pay Attention to the Code Notes
Code 94610 features a few parenthetical notes with instructions that you’ll need to review before reporting the code.
The first note states that you should not report 94610 with the following inpatient codes:
This is because the National Correct Coding Initiative (NCCI) edit pairs consider 94610 inherently bundled into 99468-99472, and the service is considered part of the inpatient critical care for a neonatal, newborn, infant, or young patient. However, each pair features a modifier indicator of “1,” which means 94610 can be unbundled with an appropriate modifier if the documentation shows the service is a separate and distinct procedure.
Next, there is a note to separately report the intubation procedure. Code 94610 is the administration of the surfactant through an endotracheal tube. If the tube is already present in the patient, you cannot report the intubation procedure. However, if the pulmonologist performs endotracheal intubation prior to the surfactant administration, you’ll assign 31500 (Intubation, endotracheal, emergency procedure) to report that procedure.
The third parenthetical note tells you to report the administration code only once per dosing session. Basically, you’ll report one instance of 94610 if the physician administers one or multiple doses of the medication to the patient at encounter. On the other hand, if the provider needs to administer the surfactant multiple times during a single day, you can report multiple instances of 94610 for that date of service (DOS).
Of course, review your individual payer preferences to see how they want you to report multiple dosing episodes on the same DOS.
Lastly, 94610 is a modifier 51 (Multiple procedures)-exempt code. There are certain codes that can warrant extra pay from insurers with the use of modifier 51. Payers add this modifier when additional pay is acceptable with a certain code pair, but that’s not always possible. In cases when you won’t be able to collect extra for a second procedure, CPT® uses the universal prohibition symbol — a circle with a diagonal line from upper left to lower right. Such is the case with 94610.
Mike Shaughnessy, BA, CPC, Development Editor, AAPC
