Pulmonology Coding Alert

Question: I’m new to pulmonology coding and I’m still figuring out evaluation and management (E/M) coding. Our provider saw a patient for continuous positive airway pressure (CPAP) management and another chronic condition with prescription drug management.

How should I report this encounter?

Florida Subscriber

Answer: You will only select the appropriate E/M CPT^® code for this encounter. Code 94660 (Continuous positive airway pressure ventilation (CPAP), initiation and management) is bundled into E/M services, and you cannot unbundle the code pairing with a modifier per the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edit pairs.

For example, 94660 is a column 2 code for 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.), but the modifier indicator of “0” lets you know that Medicare doesn’t allow you to override the edit and report 94660 separately with 99213 appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service).