Respiratory Question for the Week of December 31, 2018

Question:

For the tests reported with 94680–94690 (oxygen uptake), can calculated test results be separately reported to Medicare for reimbursement in addition to the tests that are performed to derive the calculations?

Answer:

Based on the methodology utilized, the result (VO2) may be obtained by direct measure or calculation. Calculated test results are not to be separately reported to Medicare for reimbursement in addition to the tests that are performed to derive such calculations. When performed with the exercise, pulmonary or cardiopulmonary stress test, the oxygen uptake procedures are considered a component and should not be separately billed.

When documentation supports the billing of the oxygen uptake in addition to the exercise or pulmonary stress test a modifier may be appended, when applicable. When performing a cardiopulmonary stress test, the National Correct Coding Initiative (NCCI) indicates that the oxygen uptake is never separately billable by associating a modifier indicator of “0” with the code pair. Check with your Medicare payer to determine coverage for the facility.