Maximize revenue while avoiding risky practices with this unique resource as your guide

Facilities strive to maximize revenue, but, with respiratory therapy services, it’s also about avoiding risky practices — because auditors, regulators and payers are watching closely! This unique resource will guide you through charge capture and coding while helping you avoid noncompliant practices for a full range of respiratory therapy, pulmonary function testing and sleep study services.

Count on our trusted RT experts to guide you step by step through the intricacies of coding, charging, billing and documentation for this very challenging area of healthcare. Along the way, you’ll discover a wealth of dos and don’ts, equipping you to protect your compliance and revenue. We address many potential pitfalls, including insufficient documentation, unbundled coding, modifier misuse, and the inappropriate coding of services.

Features and Benefits

Updated and expanded content, including:

• Explanation of new, deleted, and revised CPT®/HCPCS codes – including two new codes and the elimination of the longstanding G-codes for outpatient pulmonary rehab
• Guidance with all RT-specific HCPCS code changes and National Correct Coding Initiative (NCCI) updates
• Comprehensive information including clarification of supervision requirements for pulmonary rehab, an audit topic that poses serious consequences for noncompliance
• Updated billing tips and expanded guidance for common problem areas such as inhalation treatments (94640) and ventilation management, including coding guidelines and clarification of confusing NCCI rules
• Expanded information and guidance specific to inhaled nitric oxide and remote monitoring services—including new codes for remote therapeutic monitoring (RTM)
• FAQ section addressing some of the most commonly asked questions and challenges observed by our experts across the country
• Special guidance with services that should not be reported, such as evaluation and management (E&M) and recreational therapy, as well as testing provided per protocol —this is a growing area of noncompliance for RT departments that focus on counting productivity
• New appendices on the COVID-19 public health emergency (PHE) and the latest OIG audits regarding coverage requirements for outpatient cardiac and pulmonary rehabilitation services

Our experts address common questions, concerns, and problem areas:

• High-risk practices inherent with polysomnography and other sleep studies, such as insufficient prior authorization and incorrect coding for home sleep study tests
• Billing issues with 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
• Medicare medical necessity coverage policies and frequency limitations
• Lack of documentation to support medical necessity

Clear, step-by-step guidance through the tasks you perform every day:

• Coding, documentation, and billing for a full range of respiratory therapy services and pulmonary function testing, plus polysomnography and other sleep studies, EEGs, home sleep testing, and penile studies
• Covers code assignments by both hospital (technical) and physician (professional) entities

A proven quick-reference approach for busy professionals:

• Easy to navigate; each section contains:
  • Descriptions and intended uses of services provided
  • Listings of the corresponding CPT/HCPCS and revenue codes, along with explanations of intended code usage
  • Modifier usage, where appropriate
  • Documentation and medical necessity requirements
  • Billing tips
  • Clinical examples
• Complete and current payment information, including:
  • Hospital Outpatient Prospective Payment System (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
  • National and local coverage determinations (LCDs/NCDs)
  • Advance beneficiary notices (ABNs)
  • NCCI, including procedure-to-procedure (PTP) and Medically Unlikely Edits (MUEs)