Pulmonology Coding Alert

Question: We currently bill for pulmonary rehab using a G0424. We have recently been questioned about using a different code for non-COPD patients. Can you tell me if the code we are currently using is appropriate to use on the non-COPD patients? If not, what should we use, and what would the appropriate modifiers be? Can you please provide guidance on the G codes for pulmonary rehab to make sure we are using these correctly?

Ohio Subscriber

Answer: You’re right in that G0424 (Pulmonary rehabilitation, including exercise [includes monitoring], one hour, per session, up to two sessions per day) can only be used when the pulmonary rehab services are provided to a patient with Chronic obstructive pulmonary disease (COPD). Only patients with moderate to very severe COPD (defined as GOLD classification II, III and IV) will be covered by G0424. For any other conditions, you are not allowed to bill the pulmonary rehab services with G0424.

If the patient has any other pulmonary-related disease, then you would have to use respiratory care codes G0237 (Therapeutic procedure to increase strength or endurance of respiratory muscles, face-to-face, one-on-one, each 15 minutes [includes monitoring]), G0238 (Therapeutic procedures to improve respiratory function, other than described in G0237, one-on-one, face-to-face, per 15 minutes [includes monitoring]), and G0239 (Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals [includes monitoring]).

Some of the pulmonary conditions for which you can use G0237, G0238 or G0239 include:

·         277.00 — Cystic fibrosis without meconium ileus

·         416.0-416.2 — Primary pulmonary hypertension-chronic pulmonary embolism

·         491.1 — Mucopurulent chronic bronchitis

·         491.22 — Obstructive chronic bronchitis with acute bronchitis

·         492.8 — Other emphysema

·         493.10-493.91 — Intrinsic asthma unspecified-asthma unspecified type with status asthmaticus

·         494.0 — Bronchiectasis without acute exacerbation

·         494.1 — Bronchiectasis with acute exacerbation

·         500 — Coal workers’ pneumoconiosis

·         501 — Asbestosis

·         502 — Pneumoconiosis due to other silica or silicates

·         506.4 — Chronic respiratory conditions due to fumes and vapors

·         714.81 — Rheumatoid lung