LCD Reference Article Response To Comments Article

Response to Comments: Respiratory Care (Respiratory Therapy)

A55984

Expand All | Collapse All
Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A55984
Original ICD-9 Article ID
Not Applicable
Article Title
Response to Comments: Respiratory Care (Respiratory Therapy)
Article Type
Response to Comments
Original Effective Date
07/09/2018
Revision Effective Date
N/A
Revision Ending Date
N/A
Retirement Date
N/A

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

N/A

Article Guidance

Article Text

Noridian's response to provider recommendations (for comment period ending 08/14/2017)

Response To Comments

Number Comment Response
1

One commenter suggested clearer language in the following statement:

  • diagnostic tests for evaluation by a physician (e.g., pulmonary function test, spirometry, and blood gas analyses).

We will change the language to read "diagnostic tests ordered by and for the evaluation by a physician or NPP (e.g., pulmonary function test, spirometry, and blood gas analyses etc.)".

2

Another commenter wrote: I'm very concerned about the plan to discontinue payment for respiratory viral PCR and stool PCR's.

We agree that respiratory viral PCR and stool PCR tests have a place in the diagnosis and potential treatment of respiratory diseases, we do not think they fit into this specific policy of Respiratory Care therapy as such.

3

Initial education of patients in the proper use of metered dose inhalers, dry powder inhalers, breath-activated inhalers and nebulizers are a key aspect for successful therapy for respiratory diseases like asthma and COPD. The initial education involves considerably more staff time than refresher training that occurs at follow-up visits. There is a defined CPT code for this procedure, 94664, "Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device".

Thank you for the comment. CPT code 94664 is in the Draft LCD and will continue to be part of the CPT codes in this Final policy.

4

One individual asked that we include the following ICD-10-CM codes to the policy:

  • J70.4 - drug -induced interstitial lung disorders, unspecified
  • J18.9 - Pneumonia, unspecified organism
  • J34.9 - Emphysema
  • J84.9 - Interstitial pulmonary disease, unspecified
  • R06.00 - Dyspnea, unspecified
  • J84.10 - Pulmonary fibrosis, unspecified
  • G47.34 - Idiopathic sleep related nonobstructive alveolar hypoventilation
  • Z01.818 - Encounter for other preprocedural examination
  • R07.89 - Other chest pain
  • D86.9 - Sacroidosis, unspecified
  • J18.9 - Pneumonia, unspecified organism
  • J45.909 - Unspecified asthma, uncomplicated
  • J43.9 - Emphysema, unspecified
  • J45.901 - unspecified asthma with (acute) exacerbation

We feel that these "unspecified" or "other" codes in the environment of ICD-10-CM already have more granular specified codes in the draft that better serve understanding the underlying disease states that these patients have.

5

One commenter felt that there was inconsistency in one of the explanatory paragraphs.

"...Medicare coverage of respiratory care (respiratory therapy) provided as outpatient hospital or extended care services depends on the determination by the attending physician (as part of his/her plan of treatment) that for the safe and effective administration of such services the procedures or exercises in question need to be performed by a respiratory therapist, physical therapists, nurses, and other qualified personnel as described by relevant state practice acts as listed above. In addition, Medicare may cover postural drainage and pulmonary exercises furnished by a respiratory therapist as incident to a physician's professional service. In order to be considered for reimbursement by Medicare, respiratory therapy services must be fully documented in the medical records. The documentation must clearly indicate that the services rendered were reasonable and medically necessary and required the skills of a licensed respiratory therapist.

We will remove the language "...and required the skills of a licensed respiratory therapist" noted above.

6

This Respiratory Care LCD includes coverage for "diagnostic tests for the evaluation by a physician (e.g., pulmonary function test, spirometry and analyses)" and also includes overlapping medical necessity requirements and CPT codes with Draft/Proposed LCD  Pulmonary Function Testing. Please consider removing the Pulmonary Function Testing requirements and associated CPT codes from the draft respiratory therapy policy and including all Pulmonary Function Testing requirements and CPT codes in Pulmonary Function Testing as it gets confusing when there are two different policies for the same service. Please consider removing the following CPT codes from Respiratory Therapy as they are already addressed in Pulmonary Function Testing:

  • 94010 - Breathing Capacity test
  • 94011 - Spirometry up to yrs old
  • 94012 - Spimtry w/brnchdil inf-2yr
  • 94013 - Meas lung vol thru 2 yrs
  • 94060 - Evaluation of wheezing
  • 94070 - Evaluation of wheezing
  • 94150 - Vital capacity test
  • 94200 - Lung function test (mbc/mvv)
  • 94250 - Expired gas collection
  • 94375 - Respiratory flow volume loop
  • 94400 - Co2 breathing response curve
  • 94450 - Hypoxia response curve
  • 94620 - Pulmonary stress test/simple
  • 94621 - Pulm stress test/complex
  • 94640 - Airway inhalation treatment
  • 94664 - Evaluate pt use of inhaler
  • 94726 - Pulm funct tst plethysmograp
  • 94727 - Pulm function test by gas
  • 94728 - Pulm funct test oscillometry
  • 94729 - Co/membane diffuse capacity
  • 94750 - Pulmonary compliance study

We feel that the codes listed above are necessary and should remain (along with the associated diagnoses) in this policy. The tests may be used along with some aspects of pulmonary therapy. Noridian, in an effort to avoid confusion, will ensure the diagnosis codes will be reimbursed in both policies.

N/A

Coding Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

CPT/HCPCS Codes

Please accept the License to see the codes.

N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L34149 - Respiratory Care
Related National Coverage Documents
N/A
SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
05/10/2018 07/09/2018 - N/A Currently in Effect You are here

Keywords

  • Respiratory Care
  • Therapy
  • Therapist