Pulmonology Coding Alert

Question: What is the correct CPT^® for the following:

• BIPAP
• EZPAP
• EZPAP with med nebulizer

Michigan Subscriber

Answer: BiPAP is noninvasive mechanical ventilation. It includes continuous positive airway pressure (CPAP) and pressure support ventilation. Since it includes CPAP, you can use CPT^® code 94660 (Continuous positive airway pressure ventilation [CPAP], initiation and management) for the initiation and subsequent management of BiPAP.

EZPAP may be utilized for lung expansion therapy. You can report this using 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device]) if the medical indication of the CPT^® code is met for treatment of the “acute airway” (in which you would combine this with the med nebulizer) or “diagnostic sputum induction.” If the purpose of EZPAP is hyperinflation of the lungs (for re-expansion), it would not qualify as 94640. You may try using an unlisted code (94799). However, the medical necessity and coverage guidelines for this service would prevent separate payment.