Coding, Billing and Reimbursement Issues

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 then done.

This guidance document is to be used as a resource to provide you with information on coding, and most importantly, to encourage you to join the AARConnect Coding Community, where you can ask questions, discuss, and seek guidance from other members on coding issues. Please keep in mind the first line of defense is to work with your facility’s coding and billing personnel; they are the true experts.

Join the AARConnect Coding Community
AARC members can discuss issues related to coding and billing on the AARConnect Coding Community. Please note however, this discussion group should serve only as a starting point to explore with your own coding professionals the proper way to code a service or a procedure. Join the AARConnect Coding Community.

Coding Guidelines

Useful Coding links:

CPT Coding System
The AMA’s CPT coding system is, of course, the most useful and most used sets of codes accepted by private insurers, state health programs and the Medicare program. The CPT coding is a proprietary product and coding books are available through AMA membership or purchase. Again, the billing office for your facility is most likely to have a copy of the appropriate coding books. However, the AMA does provide a number of publicly accessible files on the AMA web site you might find useful.

The Medicare program, under the auspices of the Centers for Medicare and Medicaid Services (CMS), also has companion codes to the AMA CPT codes. These are termed HCPCs, or the Healthcare Common Procure Codes. This is a coding system that is used primarily to identify products, supplies, and services, such as ambulance services and durable medical equipment, drugs, etc. The HCPCs do not have a copyright and may be used by the public. Here is the CMS link to information on these codes.

The CMS site also has information on international classification system of diseases, functionality and disability called the International Classification of Diseases, Clinical Modification or ICD-9- CM. This information and data is maintained by the National Center for Health Statistics’, a department of the Centers for Disease Control and Prevention (CDC). More information on ICD-9-CM can be found here on both the CMS and NCHS web sites.

Effective October 1, 2014, CMS will transition from ICD-9 code sets to ICD-10 code sets to report medical diagnoses and inpatient procedures.. This transition is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). CPT coding for outpatient procedures and physician services are not affected by this change. There is a wealth of information on the CMS web site including timelines, implementation planning, regulations, frequently asked questions, resources, and the ability to sign-up for e-mails to receive updates as the transition moves forward.

CMS Billing Procedures
You might also find this CMS site useful as it contains information on billing procedures for a number of Medicare covered facilities.

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