Pulmonology Coding Alert

Question: The descriptor to CPT® code 94660 mentions the words “initiation and management.” So, if our pulmonologist initiates CPAP on the first day and provides additional instructions or performs adjustments to the device on later days, should I report only one unit of 94660 or should I report 94660 for each day on which our clinician provided this service? Also, let me know what other guidelines I need to follow when reporting this code?

Wisconsin Subscriber

Answer: As you have rightly pointed out, the descriptor to CPT® 94660 (Continuous positive airway pressure ventilation [CPAP], initiation and management) includes the phrase “initiation and management.” According to this, you have to use 94660 when your pulmonologist initiates or instructs the patient on the use of the CPAP device.

Since the descriptor also mentions the word “management,” you can use the same code to report your clinician’s services when the patient returns back to your clinician for any adjustment to the device or when he needs any additional guidance on the use of the device.

But, you can report only one unit of 94660 for one calendar date of service. This goes to say that if your clinician is providing the additional services following initiation on the same date of service, you will only report one unit of 94660 for that date. However, if the additional service happens on the next day or any other day, you report 94660 for the date of initiation and again additional units of 94660 for additional dates of service.

Although this service mandates that you can claim 94660 only if your clinician provides face-to-face service, it does not need your clinician to be with the patient throughout the length of the session.

You can bill this service “incident-to” if your clinician initiated the service and another trained person follows up on the service. The follow-up service will not require your clinician to be present in the room but must be in the office area, and the other person who is following up on the service should be following up on a documented care plan that was initiated by your clinician. The trained person (such as a RN, RT or a NPP) who is following up on the service should possess the necessary skill sets to execute the service. This can only be done in the office setting.