Coding, Billing and Reimbursement Issues

Respiratory Care Coding Guidelines

Coding for respiratory and pulmonary services and procedures is becoming increasingly complex, and insurers are scrutinizing billing and questioning charges more intently. It is important to code right the first time, which may be easier said than done. AARC’s Advocacy and Government Affairs staff has compiled Coding Guidelines to be used as a resource for the most common respiratory billing procedures. However, it is important to remember that the first line of defense is to work with your facility’s coding and billing personnel. They are the experts and can work with the Medicare contractors and private insurers that pay the claims if there are billing or coding questions or issues that need clarification.

AARConnect Coding Community

Have a coding question? Not sure how to code for a particular service? Want to know coding issues your peers are concerned about and how their hospitals are dealing with them? AARC members can discuss issues related to coding and billing, ask questions and seek guidance from other members on the AARConnect Coding Community. Join the AARConnect Coding Community today and participate in open discussions that offer advice and helpful information.

Coding Systems

Current Procedural Technology® (CPT) Coding System

The Current Procedural Technology (CPT) Coding system is a proprietary system maintained by the American Medical Association (AMA) and contains a listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians. This nationally accepted uniform coding system is also referred to as Healthcare Common Procedure Coding System (HCPCS) Level 1 codes. The AMA’s CPT Editorial Panel is in charge of reviewing new coding requests and modifications to existing codes, which are updated annually.

Healthcare Common Procedure Coding System (HCPCS)

The Medicare program, under the auspices of the Centers for Medicare and Medicaid Services (CMS), maintains Level II of the Healthcare Common Procedure Coding System (HCPCS). This standardized alphanumeric coding system is used primarily to identify products, supplies, and services not included in the CPT code set, such as ambulance services and durable medical equipment when used outside a physician’s office. While these codes are used extensively to identify items and services, it is important to note that the existence of a code does not, of itself, determine coverage or non-coverage for an item or service. Only Medicare Administrative Contactors who establish local coverage determinations and review Medicare claims can determine the appropriateness of coverage and payment and whether the service is medically necessary. New code requests, reconsiderations of existing codes and modifications to existing codes are updated annually by CMS.

International Classification of Diseases (ICD-10-CM/PCS)

The ICD-10-CM/PCS coding system is mandated by the Health Insurance Portability and Accountability Act (HIPAA) and became effective October 1, 2015. It is used by physicians, other health care providers, and payers to classify diseases, injuries, health encounters and inpatient procedures. The “CM” stands for Clinical Modifications and is used for medical diagnoses. The “PCS” is a new Procedure Coding System developed for inpatient procedures. Updates to the ICD-10 code set are made yearly and are effective Oct. 1. The ICD-10 Coordination and Maintenance Committee (C&M) is a Federal interdepartmental committee comprised of representatives from Centers for Medicare and Medicaid Services CMS and the Center for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS). The committee is responsible for approving coding changes, developing errata, addenda and other modifications.

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