Coding changes have arrived for 2022, and some key new codes are now available for respiratory therapy. These new codes are intended for remote therapeutic monitoring. With such new codes in play, coders and compliance officers may have several questions surrounding the coding. When is it appropriate to use each code? What should I know about the codes themselves before reporting? By reviewing the fundamentals and rationale, coders can better understand how and when to code for these services for success throughout the year.
Cracking Therapeutic Monitoring Coding for Accurate Reporting
Effective this year, codes 98975 and 98976 are available to report remote non-physiologic, therapy response/adherence monitoring services related to respiratory system status during a 30-day period. So, what are the circumstances where each code should be reported? Code 98975 may be reported for the set-up and patient education on using the device. Code 98976 is billed for reporting the supply of the device for scheduled recordings or programmed alert transmissions. Understand that like RPM, codes 98975, 98976 are not reported if monitoring is fewer than 16 days. However, unlike RPM, data can be self-reported by the patient to the practitioner as opposed to requiring automatic transmission by the device.
| 98975 | Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment
Revenue Codes: 0410, 0419, 051x |
| 98976 | Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days
Revenue Codes: 0410, 0419, 051x |
Note that code 98975, which encompasses the initial work associated with onboarding new patients, equipment setup, and patient education, is reported for each episode of care. What about codes 98980 and 98981? These codes are used to report remote therapeutic monitoring treatment management services performed by other qualified health care professionals in addition to physicians.
| 98980 | Remote therapeutic monitoring treatment management services, physician or other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient or caregiver during the calendar month; first 20 minutes
Revenue Codes: 096x, 098x |
| +98981 | Each additional 20 minutes (List separately in addition to code for primary procedure)
Revenue Codes: 096x, 098x |
More Expert Billing Insight
From a billing perspective, code 98981 may be reported when appropriate with 98980, an add-on code for each additional 20 minutes of time. Note that these are time-based codes requiring at least one interactive communication with the patient or caregiver during the calendar month. Documentation is an especially vital component when coding for this service. Pay particular attention to documentation practices to fully support charges.
When performed in the outpatient setting, code 98975 is reimbursed by CMS according to APC 5012. CPT® 98976 is designated as having a status indicator of “Q1.” A “Q1” is an “STV-packaged” procedure. A procedure that has this designation may be separately reported to Medicare, but separate payment will be received only if no other status indicator “S,” “T,” or “V,” APC reimbursed procedure is billed on the same claim. Codes 98980 and +98981 are assigned an APC status indicator of “B” while being payable to the interpreting physician or other qualified health care professional.
Explore more billing tips and insight for respiratory CPT coding solidified by our nationally renowned experts. As part of our “Breathe Easy, March is Respiratory Therapy Month,” enjoy 20% off of our 2022 RT/Pulmonary Function: 3-Part Coding, Billing & Compliance Set or any of our single products. Now is the best time to act, offer expires 3/31!
