Pulmonology Coding Alert

Can you report CPAP and E/M codes together? Find out.

Providers use positive airway pressure and negative pressure to assist patients with breathing difficulties. The CPT^® code set includes separate codes for positive and negative pressure therapies, but guidelines and NCCI edits can cause hiccups in your coding plans.

That’s why Pulmonology Coding Alert has pulled together these best practices to boost your CPAP and CNP coding success.

1. Know What’s Bundled Into Critical Care Services

Evaluation and management (E/M) codes include several procedures and services that cannot be reported separately. For example, critical care service codes 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 (… each additional 30 minutes (List separately in addition to code for primary service)) inherently include the following ventilator service codes:

• 94002-94004 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing …)
• 94660 (Continuous positive airway pressure ventilation (CPAP), initiation and management)
• 94662 (Continuous negative pressure ventilation (CNP), initiation and management)

According to CPT^® guidelines, you cannot report the ventilator management codes listed above separately with critical care services since the ventilator management service codes are inherently bundled into 99291 and +99292.

In addition to the CPT^® guidelines, the National Correct Coding Initiative (NCCI) edits instruct you to never bill ventilator management with an E/M code. If your pulmonologist performs an E/M visit and ventilator management, you’ll need to review the physician’s documentation to confirm which code to report, and there may be times where the correct code choice is unclear.

Best practice: Thoroughly review your physician’s documentation to make the appropriate coding decision. You’ll choose either a ventilation management code or an E/M code depending on what the provider documents in the medical record.

If you see that the pulmonologist focused more on ventilation management and the necessary E/M elements are missing, then you’ll report a vent management code. However, if the physician performs and documents the key components of an E/M visit beyond vent management, then you’ll select the correct E/M code. In other words, “best practices would be choosing the correct code based on the documentation and querying the provider if there is a question,” says Sheryl McCall, BS, inpatient coder at UNC Health Pardee in Hendersonville, North Carolina.

2. Use 94660 for CPAP and BiPAP Procedures

Regardless of whether the provider’s documentation includes continuous positive air pressure (CPAP) or bilevel positive airway pressure (BiPAP or BPAP), you’ll assign 94660 for the service. When you look for BiPAP or BPAP in the CPT^® code set index, your search won’t turn up anything, but fear not. Why? “It gets tricky for coders when it comes to use of BiPAP, as there is no specific CPT^® code for this service. BiPAP initiation and management is coded to 94660 for CPAP, per the American Medical Association (AMA),” says Jennifer Connell, BA, CPPM, CPCO, CDEO, CPMA, CPB, CRC, COC, CPC, CPC-P, CPC-I, CCC, CCVTC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CUC, ROCC, CEMA, CMCS, CMRS, AAPC Approved Instructor, revenue cycle director for Citizens Medical Professionals in Victoria, Texas.

Positive airway pressure therapy delivers positive pressure to the patient’s airway at a constant or variable level. The positive pressure helps keep the patient’s airways open to prevent the airways from collapsing while the patient is suffering from respiratory distress or while they sleep. Positive airway pressure is provided by a CPAP or BiPAP device. A CPAP forces pressurized air into the airway to keep the airway open, whereas a BiPAP uses one positive pressure for inhalation and another positive pressure for exhalation.

“CPAP and BiPAP can only force air at a single or dual pressure, respectively, into the lungs but cannot move the air in and out of the lungs like a ventilator,” Connell says.