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CPAP inititation

  1. Question CPAP inititation
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    We have a pulmonology doctor who is coding 94660 for a CPAP initiation along with an office visit. He is using a diagnosis code like sleep apnea for the CPAP and is using a specific diagnosis code for patients symtoms other than sleep apnea (as patients have other issues when coming in to the office). We are getting denied the office visit from Medicare stating that the office visit is included in the CPAP. We cannot use a modifier with the office visit according to CCI edits. We are looking for some guidance regarding these charges please.

  2. #2
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    Quote Originally Posted by schandler View Post
    We have a pulmonology doctor who is coding 94660 for a CPAP initiation along with an office visit. He is using a diagnosis code like sleep apnea for the CPAP and is using a specific diagnosis code for patients symtoms other than sleep apnea (as patients have other issues when coming in to the office). We are getting denied the office visit from Medicare stating that the office visit is included in the CPAP. We cannot use a modifier with the office visit according to CCI edits. We are looking for some guidance regarding these charges please.
    If CPAP initiation is all that was done, then that's all you can bill. If the E/M was more extensive than just the CPAP fitting, then I'd bill the E/M if it's more expensive. The CCI edits show a status of 9 for 94660 aas the column 1 code, then an E/M in column 2; but if you switch the order and have the E/M in column 1, then 94660 in column 2, the status is "0", meaning only the E/M is payable, and no modifier is allowed. The MDM should be pretty high on this, so you should be able to billa high level E/M, if all of the elements are documented properly. Hope that helps!

  3. #3
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    If you addressed other problems, try modifier 22 on your E/M, or a prolonged services add-on code.

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