How To Use CPT Code 94625

CPT 94625 describes the services provided by a healthcare professional for outpatient pulmonary rehabilitation without continuous oximetry monitoring. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 94625?

CPT 94625 can be used to describe the services provided by a healthcare professional for outpatient pulmonary rehabilitation without continuous oximetry monitoring. This code is used when the provider performs a session of pulmonary rehabilitation to help a patient with a chronic respiratory illness improve their quality of life. The session typically includes education and exercise tailored to the patient’s needs.

2. Official Description

The official description of CPT code 94625 is: ‘Physician or other qualified health care professional services for outpatient pulmonary rehabilitation; without continuous oximetry monitoring (per session).’

3. Procedure

  1. The healthcare professional assesses the patient’s chronic respiratory illness and determines the need for outpatient pulmonary rehabilitation.
  2. A treatment plan is developed for the patient, including curriculum-based education and exercise.
  3. The healthcare professional schedules a session for the patient, which may include the use of exercise equipment such as treadmills, bikes, and pulleys.
  4. During the session, the healthcare professional provides education on self-management and advance care planning, as well as prescribed exercise based on the patient’s treatment plan.
  5. The provider assesses the patient’s outcomes and progress during the session.
  6. The session does not involve continuous oximetry monitoring to measure the level of oxygen in the blood.

4. Qualifying circumstances

Patients eligible to receive CPT 94625 services are those with a chronic respiratory illness who would benefit from outpatient pulmonary rehabilitation. This code is used when the session does not involve continuous oximetry monitoring. The healthcare professional providing the services must be a physician or other qualified health care professional.

5. When to use CPT code 94625

CPT code 94625 should be used when a healthcare professional provides outpatient pulmonary rehabilitation services without continuous oximetry monitoring. This code is appropriate for each session provided to the patient.

6. Documentation requirements

To support a claim for CPT 94625, the healthcare professional must document the following information:

  • Patient’s chronic respiratory illness and the need for outpatient pulmonary rehabilitation
  • Specific treatment plan, including curriculum-based education and exercise
  • Date and duration of the session
  • Topics covered during the session, such as self-management and advance care planning
  • Exercise prescribed and equipment used
  • Assessment of the patient’s outcomes and progress

7. Billing guidelines

When billing for CPT 94625, ensure that the session does not involve continuous oximetry monitoring. Use the appropriate CPT code for each session provided to the patient. Consider payer policies for specific requirements related to pulmonary rehabilitation coverage.

8. Historical information

CPT 94625 was added to the Current Procedural Terminology system on January 1, 2022. There have been no updates to the code since its addition.

9. Examples

  1. A healthcare professional providing outpatient pulmonary rehabilitation services to a patient with chronic obstructive pulmonary disease (COPD) without continuous oximetry monitoring.
  2. A physician conducting a session of pulmonary rehabilitation for a patient with asthma, focusing on education and exercise.
  3. A qualified health care professional guiding a patient with cystic fibrosis through a session of outpatient pulmonary rehabilitation, including prescribed exercise.
  4. A provider delivering outpatient pulmonary rehabilitation services to a patient with interstitial lung disease, emphasizing self-management and advance care planning.
  5. A healthcare professional conducting a session of pulmonary rehabilitation for a patient with bronchiectasis, incorporating education and exercise tailored to the patient’s needs.
  6. A physician or other qualified health care professional providing outpatient pulmonary rehabilitation services to a patient with pulmonary fibrosis, without continuous oximetry monitoring.
  7. A provider delivering pulmonary rehabilitation services to a patient with chronic bronchitis, focusing on education and exercise.
  8. A healthcare professional guiding a patient with emphysema through a session of outpatient pulmonary rehabilitation, including prescribed exercise and education on self-management.
  9. A qualified health care professional conducting a session of pulmonary rehabilitation for a patient with pulmonary hypertension, emphasizing self-management strategies and exercise.
  10. A provider delivering outpatient pulmonary rehabilitation services to a patient with sarcoidosis, without continuous oximetry monitoring, focusing on education and exercise.

Similar Posts

Leave a Reply

Your email address will not be published. Required fields are marked *