Pulmonology Coding Alert

Question: During a follow-up appointment, a patient with cystic fibrosis received chest physical therapy in the office. The pulmonologist administered mechanical therapy with a chest wall oscillation system. After the therapy session, the pulmonologist demonstrated breathing control, percussion, and vibration techniques to the patient.

How do I report this encounter?

New York Subscriber

Answer: You’ll assign 94669 (Mechanical chest wall oscillation to facilitate lung function, per session) to report the mechanical therapy administered by the pulmonologist. During mechanical manipulation, the provider may use a high-frequency chest wall oscillator (HFCWO) device, which can look like a vest. The HFCWO device features a band that fits around the patient’s chest, and the band is connected to a drive. The drive applies an oscillating compressive force when activated.

HFCWO devices are reported using durable medical equipment (DME) HCPCS Level II codes and are covered under the DME benefit. DME codes are typically reported to the payer by the DME supplier, not the physician’s office. The DME supplier is reimbursed based on the rental or purchase price of the equipment. Therefore, you won’t bill DME codes, such as E0483 (High frequency chest wall oscillation system, with full anterior and/ or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each), on the same physician’s visit claim to the patient’s medical payer.

Plus, even though the pulmonologist demonstrated chest physical therapy to the patient, you cannot assign 94667 (Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation) with 94669 due to National Correct Coding Initiative (NCCI) policy edits. Code 94667 features a modifier indicator of “0” as a column 2 code for 94669, and NCCI lists the reason as the codes are mutually exclusive procedures, which means the procedures cannot be performed during the same encounter.

Don’t forget the diagnosis code: Remember to show the reason for the encounter. You indicated in your question that the patient has cystic fibrosis, so make sure to include the appropriate ICD-10-CM code, such as one from the E84.- (Cystic fibrosis) code category.