Respiratory therapists spend most of their time helping patients breathe better. In a perfect world, that’s all they would need to be concerned with doing.
But health care is a business too, and clinicians everywhere should have a good understanding of how the services they render are paid. In health care, reimbursement is governed by Current Procedural Terminology (CPT) codes.
Each service has a code
AARC Billing Codes Committee Chair Susan Rinaldo Gallo, MEd, RRT, CTTS, FAARC, explains how it works.
“Respiratory therapists provide unique services to patients, such as pulmonary function testing, ventilator management, inhalation treatments, and other services,” Gallo said. “Such services are identified by a CPT code assigned to them.”
The codes are established and maintained by the American Medical Association (AMA) and are used to report medical services and procedures to insurance companies and other third party payers. Each CPT code has a price attached to it.
While inpatient hospitals are paid under a prospective payment system based on the patient’s diagnosis and therefore all of the services rendered to the patient are bundled into one payment, she says hospitals still keep track of the individual services provided by RTs because the number of procedures “is an important indication of productivity, which can guide staffing requirements.”
AARC has a voice
Gallo says new and revised CPT codes are reviewed on a quarterly basis by the AMA CPT Editorial Panel and updated annually. The AARC serves as the voice of the respiratory care profession in these reviews.
“The AARC sends an advisor to the meetings who is a member of the CPT Health Care Professionals Advisory Committee,” said Gallo, who currently serves in this capacity.
Committee members are informed about new or revised proposals prior to the CPT Editorial Meetings. When those proposals involve respiratory services, the AARC is given a chance to comment and indicate whether or not the application has AARC support.
Other types of code changes aimed at preventing improper billing are addressed by Centers for Medicare & Medicaid Services (CMS), and the AARC plays a role in that process as well.
“For example, in the past we have sought advice and clarification from CMS on behalf of our members on changes to reporting inhalation treatments,” Gallo said.
How can respiratory therapists keep up with changes taking place in CPT codes?
“It takes diligence,” said AARC Associate Executive for Advocacy and Government Affairs Anne Marie Hummel. The AARC has a number of resources that can help.
A list of coding guidelines for the most common respiratory care services is available on the Coding, Billing and Reimbursement Issues page on the AARC website. When changes in the CPT codes occur, the information is posted in the Coding Community on AARConnect.
The AARC has also published Respiratory Coding and Billing Instructions featuring a list of CPT respiratory codes with definitions, along with a description of cases in which codes cannot be billed with other services.
“The AMA also publishes a CPT coding book every year around November,” Hummel said. “This publication includes new codes and code revisions for the upcoming year and it is important to keep up with the changes to ensure services are billed appropriately.”
Asked and answered
Hummel says managers in particular should establish a connection with the coders in their facilities as well. Facility coders can provide a wealth of information managers can use to make sure they have the most current information.
She advises AARC members to join the AARC’s Coding Community.
“Doing so gives you the opportunity to have your coding questions answered, to know how other hospitals are dealing with certain coding issues, and to participate in open discussions that offer advice and helpful information,” Hummel said.
The AARC also offers several RT-specific MedLearn Coding Guide Resources for purchase in the AARC Store. 2021 editions are available now.
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