Pulmonology Coding Alert

Question: Can I use 94667 and 94668 for showing a patient how to use a flutter valve? In our office, we supply the flutter valve to the patient and because we are not DME suppliers, we don't bill the carriers for the equipment. Any suggestions on how to recoup this cost?

Oklahoma Subscriber

Answer: Devices used for patient-managed bronchial hygiene therapy do not require the expertise of a respiratory therapist for delivery of therapy. You should reserve 94667 (Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and /or evaluation) and 94668 (...subsequent) for billing of therapy that requires the expertise of the respiratory therapist to provide hands-on therapy.

Note: CPT does not include the introduction and demonstration of the flutter valve in 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device) either, so this would not be a billable service. The only way that you could capture this service is through a medically necessary E/M service.

-- The answers to the Reader Questions and You Be the Coder were provided and reviewed by Alan L. Plummer, MD, professor of medicine in the division of pulmonary, allergy, and critical care at Emory University School of Medicine in Atlanta; and Carol Pohlig, BSN, RN, CPC, ASC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.