Pulmonology Coding Alert

Question: A patient with cystic fibrosis received chest physical therapy in the office, and the pulmonologist demonstrated breathing control, percussion, and vibration techniques to the patient. The patient’s mother performed the therapy while the pulmonologist watched to be sure it was administered correctly. How should we report this service?

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Answer: You should report this initial evaluation and demonstration with code 94667 (Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation) or 94668 (… subsequent).

When manual manipulation of the chest wall by means such as cupping, percussing, and vibration is not enough to improve a patient’s lung function, the provider may perform a mechanical manipulation. For example, the provider may use a high frequency chest wall oscillator, or HFCWO, apparatus, which may look like a vest. This apparatus includes a band that is placed around the person’s chest and a drive that is connected to the chest band. The drive varies the circumference of the chest band in cycles, applying an oscillating compressive force.  If you are reporting a mechanical oscillation, you should report 94669 (Mechanical chest wall oscillation to facilitate lung function, per session). However, this service frequently has very specific guidelines for billing, so check with your payer before reporting it.