Pulmonology Coding Alert

Question: Our provider is weaning a preterm infant from a home apnea monitor and performed a pediatric pneumogram. The pneumogram was performed 20 days after the home apnea monitoring started. I’m new to coding and am unsure how to report this service.

What codes do I need to assign for my claim?

Pennsylvania Subscriber

Answer: In this case, you’ll assign only 94774 (Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; includes monitor attachment, download of data, review, interpretation, and preparation of a report by a physician or other qualified health care professional) to report the home apnea monitoring. The home apnea monitoring pneumogram is bundled into the home apnea monitoring when reported by the same provider during the 30-day period of apnea monitoring.

The pneumogram could be unbundled in some circumstances, but your payer will likely view the services in this situation as being bundled. However, you should check your individual payer’s preferences as to whether you can unbundle the services with an appropriate modifier.

Pediatric pneumograms are commonly performed in nurseries to monitor newborns, or, in your case, to provide at-home monitoring of infants with a diagnosis of apnea. Sensors attached to the infant are used to detect the patient’s heart rate, oxygen level, the flow of air into the lungs while the patient sleeps, and the amount of effort required to breathe. The recordings can last from 12 to 24 hours.

An interpreting provider reviews and interprets the data, while identifying any abnormalities in breathing patterns and any irregular heartbeat.