A convenient, trusted guide to coding and billing for a full range of services.
This indispensable resource — actually two resources in one — provides complete guidance with coding, charging, billing and documentation for respiratory therapy/pulmonary function services AND sleep studies/polysomnography. Convenient, yes, but it's also relevant and reliable. Our expert authors focus on helping you capture the full, appropriate payment for RT/PFT and sleep study services, while keeping you out of hot water due to risky practices such as unbundled coding, modifier misuse, incorrect billing for breathing treatments and missing documentation.
Features and Benefits
- Updated with NEW information:
- Payment update for CPT® code 36415 (specimen collection, venipuncture)
- Answers to questions regarding inhalation therapy, addressing episode of care, NCCI edits, continuous treatment, modifier usage and more
- Guidance with billing for oxygen therapy, including clarification of measurable units
- Avoiding over-utilization of continuous overnight code (94762) for pulse oximetry
- Clarification of what's billable by the therapist vs. provider for smoking cessation
- Updated guidance with CPAP coding and billing
- Step-by-step through coding and billing for a full range of respiratory therapy services and pulmonary function testing, plus sleep testing, polysomnography, home sleep testing and penile studies
- Comprehensive — encompasses Medicare payments, medical necessity, national and local coverage determinations (LCDs/NCDs), advance beneficiary notices (ABNs), National Correct Coding Initiative (NCCI) edits, modifier usage, CPT/HCPCS codes, documentation requirements and more
- Covers code assignments by both hospital (technical) and physician (professional) entities
- Sections on specific services include:
- Descriptions and intended uses of the services provided
- Listings of the corresponding CPT®/HCPCS and revenue codes, along with explanations of intended code usage
- Billing tips
- Clinical examples
- Complete payment information, including current hospital OPPS rates, procedures with APCs, status indicators and at-a-glance tables showing CPT/HCPCS codes included in APCs, plus prior year and current payment rates
- Special help with common areas of confusion and noncompliance, such as:
- Billing issues, including breathing treatments — a prime RAC target — and billing sequence or date of service
- Unbundling of codes and groups of CPT/HCPCS codes that are inappropriately reported together
- Incorrectly billing for routine monitoring, oxygen and services not specifically ordered by a physician
- Interpreting Medicare medical necessity coverage policies and frequency limitations
- Lack of documentation to support medical necessity
- Incorrect coding for home sleep study tests
® is a registered trademark of the American Medical Association.
For certain MedLearn Publishing publications, you will see an 'AMA Royalty for CPT Editorial Content' in your shopping cart. This charge covers the licensing fee MedLearn Publishing pays to the American Medical Association (AMA) for references to CPT
® codes. The AMA owns the copyright for CPT codes.