Confused? Questions? Here’s what you need to know
“Which of our respiratory therapy services are billable?” “How do we code for pulmonary function testing?” In their consulting engagements, MedLearn experts frequently hear these and other questions that can significantly affect revenues and regulatory compliance. The answers are clearly laid out in our Coding Essentials for Respiratory Therapy/Pulmonary Function book. Highlights:
- Step-by-step guidance through CPT® code usage and format, modifiers and chargemaster review methods
- Clarification of which services are billable and which are not
- How to avoid common mistakes, such as the unbundling of codes for pulmonary function testing
- Billing rules for respiratory therapists vs. nursing personnel
- Detailed explanation of the CCI and how to interpret CMS edit tables
- Overview of Medicare medical necessity coverage policies and frequency limitations
- 2011 APC payment rates and guidelines from the Medicare Hospital Manual
- NEW FOR 2011:
- New HCPCS codes for smoking cessation counseling and sleep studies, along with what they mean for your hospital
- Key revisions to code definitions and instructions, including recommended action steps
- The latest CMS guidance related to pulmonary rehabilitation services
- Listing of Medicare local coverage determination (LCD) policies
- Links to Medicare FI/MAC LCD web sites (eBook format only)
Findings from MedLearn consulting experts
MedLearn consulting experts speak from their real-world experiences regarding the potential benefits of Coding Essentials for Respiratory Therapy/Pulmonary Function to healthcare organizations:
RAC targeting bronchoscopy — “In the coming months, you can expect the Recovery Auditor Contractor (RAC) program to closely examine claims for bronchoscopy and pulmonary rehab services. Our Coding Essentials book is designed to help hospitals align their practices with proper charge capture practices, resulting in correct payment and the prevention of RAC recovery initiatives.”
Lost revenues for oxygen — “We’ve documented several instances of hospitals missing charges for oxygen and related gases. The implications can be substantial. In one case, we found that a hospital was losing about $80,000 year by not charging for oxygen. By carefully following the guidelines in our book, these lost reimbursements can be avoided.”
Missed charges for arterial puncture — “Many facilities don’t realize that arterial puncture is a chargeable service. Consequently, they may be forgoing substantial revenues — potentially $100,000 or more. We lay it all out: which services are appropriately billed and which are not.”
Unbundled billing for PFT — “One of the biggest mistakes we see involves a common procedure: the pulmonary function test. Respiratory therapy departments routinely unbundle the CPT code for spirometry and then bill the components individually. Mistakes like these are often due to misinterpreting CPT codes…a deficiency that can be remedied by consulting this book.”
To bill or not to bill — “As essential as they are, many respiratory therapy services are simply not billable, and departments expose themselves to regulatory action by continuing to submit claims for these services. A top priority for us is clearly distinguishing between billable and non-billable services.”
Information overkill — “Many respiratory therapy departments don’t own the current, official CPT manual because so little of it pertains to them. Consequently, they may not be up to date on crucial CPT code definitions and guidelines. Coding Essentials for Respiratory Therapy/Pulmonary Function contains RT-specific coding information, which not only saves time for users, but it may promote better assimilation of the knowledge they need.”
CPT is a registered trademark of the American Medical Association
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