Pulmonology Coding Alert

Question: We are a pulmonology clinic plus a sleep lab with two beds, and we bill for both services as a clinic. We would like to fit our patients with continuous positive airway pressure (CPAP) machines. Can we set up a durable medical equipment (DME) unit for taking care of our own patient population? Also, how should we bill for the follow-up treatment visits?
North Carolina Subscriber
Answer: When you manage the patient's follow-up care, you should use 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient É) to capture the professional services. Before pursuing the DME option, you should consult with an attorney. Although sleep studies (polysomnography 95808-95811) are not a designated health service (DHS), CPAP equipment is. So although you can refer patients to a lab that you have a financial interest in for the study and be OK, Stark kicks in for the CPAP dispensing under DME. Stark II law prevents the sleep lab owner (or referral source) from also owning a medical equipment company, unless it represents "an extension of practice" for the sleep provider. An attorney well-versed in healthcare law and Stark could make this distinction. Even so, managed-care companies often designate specific providers for services, similar to capitated lab services.