Pulmonology Coding Alert

Question: Our practice treats many patients with sleep apnea. We give out take-home continuous positive airway pressure (CPAP) machines to some of them. Recently, an established patient with primary central sleep apnea reported to the pulmonologist. After a level-two E/M, the physician performed CPAP initiation and sent the patient home with the machine. A week later, the same patient reported to the office, and a nurse practitioner (NP) adjusted the pressure settings on the machine. Is this follow-up visit codeable?

Wisconsin Subscriber

Answer: You can code the follow-up visit separately, but you cannot report an E/M service along with CPAP initiation. Check out this coding advice, which is split to reflect the separate encounters:

Encounter 1: On the claim, report the following:

• 94660 (Continuous positive airway pressure ventilation [CPAP], initiation and management) for the initiation

• 327.21 (Primary central sleep apnea) linked to 94660 to represent the patient's condition.

Encounter 2: On the claim, report the following:

• 94660 for the CPAP management

• 327.21 linked to 94660 to represent the patient's condition.

Choose E/M or 94660: The reimbursement for 94660 is higher than it is for a level-two office visit. For the initial encounter, you can code either 94660 or 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history; a problem-focused examination; straightforward medical decision-making) -- but do not code both.