Pulmonology Coding Alert

Question: Our pulmonologist often performs chest physical therapy (CPT) for patients with cystic fibrosis. Which codes should we report for this?

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Answer: CPT to assist the patient in clearing secretions is typically coded with 94667 (Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation) or 94668 (Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent).

Your pulmonologist may need to employ the CPT service in not just the outpatient clinic but in a variety of settings, including a critical care unit, a hospital room, nursing homes, outpatient clinics, and perhaps in the patient's home.

What to do: If an external provider, such as a respiratory therapist, nurse, or physical therapist is called in to perform CPT, he/she should not initiate the service unless there is an initial prescription from a pulmonologist. This prescription should identify the patient, list the diagnosis, describe the frequency of visits, and define the duration of the treatment regimen.

Make sure you meet the following guidelines to justify CPT treatment by a registered provider:

• There is a documented treatment plan to stabilize the patient's status.
• The patient's pulmonary condition is unstable.
• A caregiver, such as a family member, can commit to performing CPT on the patient on a regular basis.

Example: A CF patient is given a prescription to receive CPT in the home. Initially, a pulmonologist, nurse, or respiratory therapist will explain and demonstrate techniques such as breathing control, percussion, and vibration techniques. The patient or his caregiver performs the therapy under the health professional's observation to be sure it can be done correctly. You should report this initial evaluation and demonstration with code 94667.

When manual manipulation of the chest wall by means such as cupping, percussing, and vibration is not enough to improve a patient's lung function, the provider may perform a mechanical manipulation. For example, the provider may use a high frequency chest wall oscillator, or HFCWO, apparatus, which may look like a vest. This apparatus includes a band that is placed around the person's chest and a drive that is connected to the chest band. The drive varies the circumference of the chest band in cycles, applying an oscillating compressive force. If you are reporting a mechanical oscillation, you should report 94669 (Mechanical chest wall oscillation to facilitate lung function, per session).