AmyLitterell
Networker
Hello! I need help with the requirements to bill this code. The 2011 CPT book has this listed as: 94620 Pulmonary Stress Testing:Simple (6 minute walk test, prolonged exercise test for bronchospasm with pre & post spirometery & oximetry.
Does this mean it is either a 6 minute walk test OR a prolonged exercise test?
My Dr gave me information from a company called Respironics and they state in their literature that "According to the AMA, spirometry is listed as an example in the code's description, but not a required test when billing for this code".
I have found conflicting information online @ MedLearn.com in their Respiratory compliance archive:
February 8, 2010
Question:
I receive many emails from our billing staff about medical necessity for a simple stress test 94620. They say that the code is an active one in our intermediary's local coverage determination (LCD) for pulmonary rehabilitation services, and they sent me a list of diagnosis codes. But we are not using 94620 in relation to pulmonary rehab, and we do not encounter the diagnoses listed in the LCD. We use the test as part of a diagnostic work-up for heart failure patients, and the the code represents a fair amount of reimbursement for what we do.
Answer:
You don't have a medical necessity issue, you have a coding and semantics issue.
The procedure that you are actually performing, as evidenced by the records you provided to us, is CPT 94761--pulse oximetry for oxygen saturation, multiple determinations (e.g., during exercise). In order to report CPT 94620, pre and post spirometry as well as oximetry must be performed. In the records provided, I see no evidence of spirometry testing. Heart rate, blood pressure and pulse oximetry are the only parameters measured.
The CHFPA 6 Minute Walk Test, as defined on the form used to report the study, is a cardiopulmonary exercise test, not the walk test defined by CPT 94620.
Implement reporting of CPT 94761, and medical necessity shouldn't be an issue
OR
February 1, 2010
Question:
Could you please review appropriate performance and reporting of the six-minute walk test that is reported with 94620?
Answer:
The descriptor for CPT 94620 was revised in 2007 to include a six-minute walk test and oximetry in the example in the descriptor. A six-minute walk test that evaluates distance, dyspnea, oxyhemoglobin desaturation and heart rate can be reported with CPT 94620 according to the AMA July 2005 CPT Assistant. Spirometry is not required but the heart rate, blood pressure, oxygen saturation are to be be reported at rest, during exercise, and during recovery. The CPT Assistant points out that a six minute walk test with no objective ventilatory assessments should should be reported with CPT 94761, noninvasive ear or poulse oximetry for oxygen saturation; multiple determinatios (eg, durging exercise).
No LCD/NCD for my region either
So what are the requirements?
Thank you!!
Amy
Does this mean it is either a 6 minute walk test OR a prolonged exercise test?
My Dr gave me information from a company called Respironics and they state in their literature that "According to the AMA, spirometry is listed as an example in the code's description, but not a required test when billing for this code".
I have found conflicting information online @ MedLearn.com in their Respiratory compliance archive:
February 8, 2010
Question:
I receive many emails from our billing staff about medical necessity for a simple stress test 94620. They say that the code is an active one in our intermediary's local coverage determination (LCD) for pulmonary rehabilitation services, and they sent me a list of diagnosis codes. But we are not using 94620 in relation to pulmonary rehab, and we do not encounter the diagnoses listed in the LCD. We use the test as part of a diagnostic work-up for heart failure patients, and the the code represents a fair amount of reimbursement for what we do.
Answer:
You don't have a medical necessity issue, you have a coding and semantics issue.
The procedure that you are actually performing, as evidenced by the records you provided to us, is CPT 94761--pulse oximetry for oxygen saturation, multiple determinations (e.g., during exercise). In order to report CPT 94620, pre and post spirometry as well as oximetry must be performed. In the records provided, I see no evidence of spirometry testing. Heart rate, blood pressure and pulse oximetry are the only parameters measured.
The CHFPA 6 Minute Walk Test, as defined on the form used to report the study, is a cardiopulmonary exercise test, not the walk test defined by CPT 94620.
Implement reporting of CPT 94761, and medical necessity shouldn't be an issue
OR
February 1, 2010
Question:
Could you please review appropriate performance and reporting of the six-minute walk test that is reported with 94620?
Answer:
The descriptor for CPT 94620 was revised in 2007 to include a six-minute walk test and oximetry in the example in the descriptor. A six-minute walk test that evaluates distance, dyspnea, oxyhemoglobin desaturation and heart rate can be reported with CPT 94620 according to the AMA July 2005 CPT Assistant. Spirometry is not required but the heart rate, blood pressure, oxygen saturation are to be be reported at rest, during exercise, and during recovery. The CPT Assistant points out that a six minute walk test with no objective ventilatory assessments should should be reported with CPT 94761, noninvasive ear or poulse oximetry for oxygen saturation; multiple determinatios (eg, durging exercise).
No LCD/NCD for my region either
So what are the requirements?
Thank you!!
Amy
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