Pulmonology Coding Alert

Question: A pulmonologist orders home chest physiotherapy (CPT) by a respiratory therapist for a child with chronic asthma. The child also has gastric reflux and receives tube feedings, when his respiratory condition is unstable. Can I report this procedure even if it is administered at home? What code should I use?

Answer: No. A pulmonologist or any other physician cannot bill for an order for therapy given in the home. This would include home chest physiotherapy, home O2 therapy, and home bronchodilator therapy.

Exception: The pulmonologist could bill for his related therapies if performed in the office. You would report 94667 (Manipulation chest wall, such as cupping, percussing, and vibration to facilitate ung function; initial demonstration and/or evaluation) or 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [eg. with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device]). You cannot report the O2 therapy, because this has no CPT or HCPCS code. You should typically include it in the E/M.

-- 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.