Pulmonology Coding Alert

Question: My pulmonologist treats a patient suffering from respiratory failure with continuous positive airway pressure ventilation (CPAP). How should I report this encounter, and what ICD-9 code would be appropriate?


Minnesota Subscriber

Answer: There is only one correct CPT code for this service; the ICD-9 code, however, depends on the type of respiratory failure the patient has and, more importantly, what is documented in the medical record. On the claim, you should:

• report 94660 (Continuous positive airway pressure ventilation [CPAP], initiation and management) for the CPAP procedure.

On ICD-9: There is a quartet of codes to choose from when the pulmonologist decides a patient has respiratory failure:

• 518.81 (Acute respiratory failure),
• 518.82 (Other pulmonary insufficiency, not elsewhere classified),
• 518.83 (Chronic respiratory failure) and
• 518.84 (Acute and chronic respiratory failure).