Pulmonology Coding Alert

Question: My pulmonologist is treating a patient suffering from respiratory failure with CPAP therapy. We use 94660. What are the applicable ICD-9 codes for the condition? How will ICD-10 change the coding next year?

Minnesota Subscriber

Answer: You are correct in coding 94660 (Continuous positive airway pressure ventilation [CPAP], initiation and management) as that is the only one correct CPT® code for this service. 

Note: The physician must provide a face-to-face encounter with the patient for the successful reporting of 94660 and you should report this code only when the treatment is initiated with the patient, in order to describe the initiation and instruction of the patient. If the patient returns and requires additional instruction on use or other issues related to the use of the CPAP device, you should report this service once again as per need.

However, you will report the ICD-9 code based on the severity and type of respiratory failure the patient has and the difference between a successful and a rejected claim would lie in your documentation of the medical record.

Respiratory failure can be captured by the code 518.8x (Other diseases of lung) with four expansions available and the fifth digit deciding the type of failure. There are four mutually exclusive codes to choose from:

• 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). 

Note: Do not include codes for pulmonary insufficiency following trauma and surgery (518.5) along with any of the above given codes.

After the ICD-10 switchover next year, 518.81 will cross over to J96.0- (Acute respiratory failure) with fifth digit (0-2) specifying the presence of hypoxia or hypercapnia.

518.82 will be identified as J80 (Acute respiratory distress syndrome). 

518.83 will walk over to J96.1- (Chronic respiratory failure) with the fifth digit expansion (0-2) capturing the presence of hypoxia or hypercapnia.

The transition of 518.84 is also relatively similar to others as the code changes to J96.2- with the fifth digit expansion (0-2) capturing the presence of hypoxia or hypercapnia.