Which statement is true regarding the coding and billing for respiratory procedures in a primary care setting?
- a. bronchospastic spirometry (CPT code 94060) can be billed on the same day as inhaler demonstration training
- b. a medical assistant can perform smoking cessation counseling and the clinician can bill for this service (CPT code 99406)
- c. personal supervision (level 3) is required to administer and bill for performing post-bronchodilator spirometry testing (CPT code 94060)
- d. the clinician must personally perform inhaler demonstration training in order to bill for this procedure (CPT 94664)
Rationale: The correct answer is A: the billing and coding rules are ever changing, so please consult additional sources to ensure that you have the most up-to-date information about this topic. A medical assistant is allowed to perform inhaler demonstration for patients and the clinician can bill for this service (D. is incorrect). However, in contrast, the clinician must personally counsel the patient on smoking cessation in order to bill for this procedure (B. is incorrect). Spirometry alone or spirometry with bronchodilator challenge cannot be billed on the same day as the 6-minute walk test because the spirometry is felt to be an integral part of the procedure, but these tests may be billed on the same day as inhaler demonstration. Only level 2 supervision (direct supervision where a physician is somewhere in the building and immediately available – but not personally required at the bedside) is required to administer bronchodilators in a clinic or hospital setting.
What must be recorded in the medical record and performed/done in a clinical setting in order to bill for a 6-minute walk test?
- a. record pulse, oxygen saturation, dyspnea, distance walked
- b. record vaccination status and smoking status
- c. performed personally by a clinician/provider
- d. requires level 2 supervision (physician in the building & immediately available)
Rationale: The correct answer is A: the billing and coding rules are ever changing, so please consult additional resources to ensure that you have the most up-to-date information about this topic. At the time this module was created, only level 1 (general supervision) is required for a simple pulmonary exercise test (i.e., 6 minute walk test) and the test can be performed by a medical assistant, nurse or respiratory therapist; however, the report must be interpreted and signed by a clinician, and the components that must be included in the report include: vital signs, oxygen saturation, dyspnea scale and distance walked.
What procedure cannot be billed on the same day as a simple pulmonary exercise test?
- a. inhaler demonstration
- b. vaccination administration
- c. pre- and post-bronchodilator spirometry
- d. smoking cessation counseling
Rationale: The correct answer is C: spirometry alone or spirometry with bronchodilator challenge cannot be billed on the same day as the 6-minute walk test because the spirometry is felt to be an integral part of the procedure. However, all other procedures such as inhaler demonstration, vaccination administration, and smoking cessation counseling may each be billed on the same day as spirometry or a 6-minute walk test as long as all documentation is appropriate.
What is true regarding the rules for billing and coding for smoking cessation counseling?
- a. incident-to billing can be used by non-physician providers
- b. should be divided in segments of 0-3 minutes, 4-5 minutes, or >5 minutes
- c. can be done by a non-physician provider or a medical assistant
- d. there is a limit of 8 visits in a 12-month period
Rationale: The correct answer is D: there is a limit of 8 visits for billing for smoking cessation counseling within a 12-month period. Non-physician providers cannot use incident-to billing (answer A. is incorrect). The time for counseling for smoking cessation counseling is divided into segments of 3-10 minutes or >10 minutes (B. is incorrect). All smoking cessation counseling that is billed must be performed by a clinician (i.e., physician or non-physician provider) and cannot be billed if performed by a medical assistant (C. is incorrect).