Health Information Management

Correctly code for new cardiac, pulmonary rehab benefits

JustCoding News: Outpatient, March 10, 2010

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To take advantage of the new Medicare benefits for cardiac and pulmonary rehab services, coders must use the correct codes for these services.

On December 11, 2009, CMS issued a change request that specified the codes for cardiac and pulmonary rehab services, as well as the time requirements for these services. View Claims Processing Manual Transmittal 1871, and find the instructions for coding cardiac, intensive cardiac, and pulmonary rehab services, which begin on p. 45.

  • Cardiac and pulmonary rehab programs must include the following:
  • Physician-prescribed exercise
  • Psychosocial assessment
  • Outcomes assessment
  • An individualized treatment plan
  • Education and training tailored to the patient’s needs

All cardiac and pulmonary rehab services must be furnished in a hospital outpatient department or a physician office, and a physician must be immediately available for consultations and emergencies.

Cardiac rehab coding

Cardiac rehab services fall under revenue code 0943. Coders should continue to use CPT code 93798 (Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring [per session]) and code 93797 (Physician services for outpatient cardiac rehabilitation; without continuous ECG monitoring [per session]). Coders can assign code 93797 for non-ECG-monitored exercise sessions and for educational sessions.

However, no codes exist to bill for the cardiac rehab initial assessment that your cardiac rehab staff provides. “It’s part of the patient’s treatment plan,” says Karen Lui, RN, MS, FAACVPR, legislative and regulatory analyst at GRQ Consulting in Washington, DC.

Hospitals and practitioners can report up to two one-hour sessions each day, but in order to report one session of cardiac rehab, the treatment must last at least 31 minutes. To report two sessions on the same day, the treatment must last for a total of at least 91 minutes—one hour for the first session and at least 31 minutes for the second session. If multiple shorter periods of cardiac rehab are provided on the same day, add the minutes of service together. If they total at least 31 minutes of service during the day, bill for a one-hour session.

In the change request, CMS outlined several scenarios with various time elements:

  • Scenario 1: The patient receives 25 minutes of cardiac rehabilitation services during one day. In this case, you cannot report a cardiac rehabilitation session because fewer than 31 minutes of services were furnished.
  • Scenario 2: The patient receives 20 minutes of cardiac rehabilitation services in the morning and 35 minutes of cardiac rehabilitation services in the afternoon of a single day. Report one session of cardiac rehabilitation services with the appropriate CPT code for the total duration of 55 minutes of services on that day.
  • Scenario 3: The patient receives 75 minutes of cardiac rehabilitation services in the morning and 25 minutes of cardiac rehabilitation services in the afternoon of a single day. Report two sessions of cardiac rehabilitation services with the appropriate CPT code(s) because the total duration of services on that day exceeds 90 minutes.
  • Scenario 4: The patient receives 80 minutes of cardiac rehabilitation services in the morning and 75 minutes of cardiac rehabilitation services in the afternoon of a single day. Report two sessions of cardiac rehabilitation services with the appropriate CPT code(s). You can only report a maximum of two sessions per day, regardless of the total duration of cardiac rehabilitation services.

In several places in the regulations, CMS states that the team providing the rehab services should be a multidisciplinary team. However, CMS does not specify who should be on the team. It does state that occupational therapists and registered dietitians may not supervise or bill separately for services provided during the cardiac rehab program, Lui says.

Physical therapists (PT) may be part of the multidisciplinary team, and they bring considerable expertise to the team. “However, it’s comprehensive cardiac rehab services that are billed, not separately as PT services. They are part of the two codes we have been given,” Lui says.

Pulmonary rehab coding

Although the codes for cardiac rehab haven’t changed, coders need to assign a new bundled G code for pulmonary rehab services: G0424 (Pulmonary rehabilitation, including exercise [includes monitoring], per hour, per session). These services fall under revenue code 0948. For hospital-based programs, the G code crosswalks to new APC 0102.

“That’s another new thing for pulmonary rehab,” says June Schulz, RRT, FAACVPR, pulmonary rehabilitation coordinator at Sanford USD Medical Center in Sioux Falls, SD. “In the past, we have not had a bundled code.”

As with cardiac rehab, hospitals and practitioners can report up to two one-hour sessions each day, but in order to report one session of pulmonary rehab, the treatment must last at least 31 minutes.
 
To report two sessions on the same day, the treatment must last for a total of at least 91 minutes—one hour for the first session and at least 31 minutes for the second session. If a patient attends multiple shorter periods of pulmonary rehab on the same day, add the minutes of service together. If at least 31 minutes of services are provided during the day, bill for a one-hour session.

CMS outlined several scenarios with various time elements:

  • Scenario 1: The patient receives 15 minutes of pulmonary rehabilitation services during the day. In this case, do not report a session because fewer than 31 minutes of services were furnished.
  • Scenario 2: The patient receives 25 minutes of pulmonary rehabilitation services in the morning and 35 minutes of pulmonary rehabilitation services in the afternoon of a single day. Report one session of pulmonary rehabilitation services under the appropriate G code for the total duration of one hour of pulmonary rehabilitation services on that day.
  • Scenario 3: The patient receives 65 minutes of pulmonary rehabilitation services in the morning and 35 minutes of pulmonary rehabilitation services in the afternoon of a single day. Report two sessions of pulmonary rehabilitation services under the appropriate G code(s) because the pulmonary rehabilitation services on that day exceeds 90 minutes.
  • Scenario 4: The patient receives 80 minutes of pulmonary rehabilitation services in the morning and 80 minutes of pulmonary rehabilitation services in the afternoon of a single day. Report two sessions of pulmonary rehabilitation services under the appropriate G code(s) because the pulmonary rehabilitation totaled more than 155 minutes. You can report a maximum of two sessions per day, regardless of the total duration of pulmonary rehabilitation services.

As with cardiac rehab, PTs can be involved in pulmonary rehab but cannot bill separately for their services. In addition, the new rules do not apply to comprehensive outpatient rehabilitation facilities. The new regulations apply only to patients with moderate, severe, or very severe chronic obstructive pulmonary disease. If patients with other lung diseases take part in pulmonary rehab, coders will continue to assign the G codes they have used in the past.

The current G codes, G0237 and G0238, are timed codes, and G0239 is billable once per day per patient. You would be able to bill for the six-minute walk and other services when using the current G codes. However, coders should remember that the walk is packaged into the new G code, G0424. The patient’s diagnosis will determine which codes are appropriate for billing.

“For years, we have been accustomed to billing for a six-minute walk and then billing other codes. Now you’re doing your six-minute walk, but it has to be bundled under that G code,” Schulz says. “That covers everything you are doing in that session.”

Editor's note: This article was originally published in the March issue of Briefings on APCs. E-mail your questions to Managing Editor Michelle Leppert at mleppert@hcpro.com.



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