94660 Requirements

dlashua

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Hi - I am hoping someone will be able to offer some guidance. Our group has a neurologist who is interested in performing CPT 94660 - The practice has hired a technician and the question has arisen as to who can actually bill for this procedure code. I have found the following:

"CPT code 94660 Description: CPAP ventilation, initiation and management
What physicians need to know: If the patient’s chief purpose for the visit to the MD’s office is to review issues related to the treatment and management of their sleep disorders, the physician can bill CPT code 94660. This code is specific to the initial education and long-term management of the patient related to CPAP (meaning the physician can bill this code multiple times for future visits depending on payor restrictions). CPT code 94660 should not be billed in addition to an evaluation and management code for the same patient service. If a separate and distinct service is offered on the same day, bill the appropriate CPT code with a -25 modifier"
The provider wants the technician to perform this service and then the physician bill.

I have also found: 98960:
"Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient" Here the NPP is specifically addressed.

I have no experience with sleep studies and do not want to give the provider bad advice. Could someone please help me with this?

Thank you in advance,
D
 

dsoule

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94660

Be careful with this. This can be billed "incident to" but per the CPT Assistant October 2014; Volume 24: Issue 10 Code 94660 includes reviewing medical history, performing a physical examination, and reviewing diagnostic test results, all focused on the management of PAP and the underlying disorder. Discussions with the patient may include various device options and masks available; prior experiences with PAP devices; desensitization therapy to manage side effects such as claustrophobia or facial lesions; ordering durable medical equipment (DME); and addressing any related health care needs. A brief chart note to document the service is included in code 94660.

So, if the technician is doing it who performs the physical exam?

Dee Soule BBA, MBAHCM, CPC, CHCA
 
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