Billing separately for RIP?

Billing separately for RIP?

Postby sleepadmin » Mon Aug 01, 2005 11:51 pm

In a training session for a new Sensormedics install, the rep stated that you can bill insurance companies for using RIP (in addition to the PSG charges). As far as I know, insurances (especially Medicare) do not allow you to charge for any concurrent monitoring devices (such as EtCO2, PTAF, NPT, etc.) Why would RIP be any different? :?

Is anyone else doing this?
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Postby somnonaut » Tue Aug 02, 2005 1:47 am

fee splitting and is illegal. The 95810 code doesn't care what extra parameters you include in your PSG beyond the minimal outfitting of channels. At that is the way we view it.
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Postby Rick » Tue Aug 02, 2005 6:58 pm

I went through the CPT code book and the only applicable codes really don't apply - they are like pulmonary function study codes. Claude is right, the old 95810 was created to encompass all parameter monitoring. I remember, in the old days having something like twenty codes to put down for each study, it was a pain.
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Postby wmack » Thu Aug 04, 2005 12:30 pm

There is no financial benefit to doing the Gold Standard as to doing the basic level of crap that some places do, only the reputation of your lab!
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Postby Rick » Thu Aug 04, 2005 3:37 pm

And the ability to be certain you have performed the most complete and thorough test available to your patients.
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Postby respbarb » Thu Aug 04, 2005 9:16 pm

you will find that in more places than just sleep medicine!
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Postby Keith » Fri Aug 05, 2005 12:06 am

Andrew,

I have worked for a couple of sleep labs that do this. I don't remember the CPT code, but it's the code for flow volume loops. The kicker there was that although we used RIP belts, we really didn't utilize the flow volume loop technology. We simply used disposable RIP belts and charged extra for it.
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Postby Keith » Fri Aug 05, 2005 12:08 am

I think it's 94375
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94375 - Respiratory flow volume loop

Postby somnonaut » Fri Aug 05, 2005 12:38 am

94375 - Respiratory flow volume loop .....................................$29

http://www.medic-us.com/resp/CPT.htm
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Postby Rick » Fri Aug 05, 2005 4:46 pm

Something seems amiss with these suggestions.

[color=darkred]Spirometry and flow volume curves are non-invasive techniques for the
measurement of vital capacity, forced expired volume in one second and
rates of airflow at various lung volumes. Measurement of the forced vital
capacity and corresponding flow rates is the most commonly used test to
detect the presence of lung disease and to monitor changes in severity and
response to treatment.


Does anyone really think that using RIP belts is the same as monitoring Flow Volume Loops?

If so, why not charge this one, too?

94660 Continuous positive airway pressure ventilation (CPAP), initiation and management

Or, how 'bout this one:

94762 Noninvasive ear or pulse oximetry for oxygen saturation by continuous overnight monitoring

You know why we don't use these CPT codes? Because they are in the Pulmonary Section. Oddly enough the CPT codes used for charging for sleep studies are listed under Sleep Testing!!!

Using those other CPT codes ("although we used RIP belts, we really didn't utilize the flow volume loop technology. We simply used disposable RIP belts and charged extra for it.") is not correct, right, or appropriate.

Can anyone spell FRAUD?
[/color]
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Postby domino512 » Sat Aug 06, 2005 9:04 pm

My billing guru's at two diferent facilities have been over this subject. It is not considered "fee-splitting" if the codes are not listed as bundled in each other. Looking at the CPT coding book is only part of the story. Your billing department should have access to the monthly updates that come out as well as the bundling data. Ask them for help.

94660 is considered "bundled" with 95811. However, if a patient comes in at a later date for further training or education, you may legally use 94660 for this service. It MUST be ordered by a physician (ie not a walk-in) and the physician MUST document review of your notes from the patient visit (our form has a place for physician to comment, sign and date.

As for the code for flow volume loops, 94275, it is NOT considered "bundled" with 95810 or 95811 (we didn't check other codes because we don't use them with any other tests). So long as we use the RIP, generate reports on loops and our physician reads the loops and documents that in his/her report, we are legally charging for them.

You may not charge for EEG, EKG, oximetry on top of 95810 or 95811...they ARE considered bundled.

So long as we're following the rules, I do not feel we are committing fraud.

Bottom line...do your own research, check the rules yourself and then make your billing decision.
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Postby GSC » Sun Aug 07, 2005 10:40 pm

I agree that we must all do our research and make an informed judgement. However, sometimes we must look at these judgement calls in the full light of what we are doing. My 4 year old went for her physical and the physician charged $50 extra for an eye exam which consisted of her reading the eye chart. One of my twins has a known heart murmur. Her physician listened to it and said yup its there but nothing to worry about. The EOB showed an extra $150 charge in addition to the physical charges since the physician "found" the heart problem. The insurance company allowed the charges...but as the consumer it sure did not feel right. With the RIP, I ask why are we using it. In our lab, we are using it to measure airflow and to assist us in getting the optimal cpap pressures. Since we are using it in this manner, we feel that it is part of the sleep study and bill only for the study. If the patient has a history that indicates that they might have a pulmonary disease, we can perform PFTs. While we may loose a small amount of money compared to others, it is a small price to pay when compared to trying to justify why we perform a flow volume loop on every patient.
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Postby Rick » Mon Aug 08, 2005 9:21 pm

Domino,
Using RIP belts is not measuring or monitoring Flow-Volume loops. Flow-Volume loops are part of a PFT. One may infer flow from a RIP belt and from that inferrence you can guess at volumes so the Flow is inferred and the volume interpolated but neither are directly measured.

Do you use other belts to measure respiratory effort so that the RIP belts are only used for these inferred and interpolated Flow-Volume loops?
Have you ever seen a pulmonary function lab that uses only RIP for their Flow-Volume loops?

RIP belts measure respiratory effort, which indeed is bundled into 95810.
Why can't one charge extra for measuring EtCO2?
I believe the point is that you are not performing any more nor less than a Polysomnogram, no matter what you may want to call the method in which you are measuring respiration, you are still measuring respiratory effort and respiratory flow, all of which is included in the 95810 and 95811. Have any diagnoses for pulmonary disease been made strictly from the PSG as a Primary Diagnosis?

I no longer work in a clinical setting but do know y'all are struggling to squeeze every last dime you can for the testing you perform but be carefull about stretching what is believeable.
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