How To Use CPT Code 94626

CPT 94626 describes the services provided by a healthcare professional during a session of outpatient pulmonary rehabilitation, which is a treatment program for patients with chronic respiratory illnesses. 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 94626?

CPT 94626 can be used to describe the services provided by a healthcare professional during a session of outpatient pulmonary rehabilitation. This treatment program is designed to help patients with chronic respiratory diseases improve their quality of life by reducing shortness of breath, increasing exercise tolerance, and enhancing overall well-being. The session includes curriculum-based education and exercise, as well as continuous oximetry monitoring to measure the level of oxygen in the blood.

2. Official Description

The official description of CPT code 94626 is: ‘Physician or other qualified health care professional services for outpatient pulmonary rehabilitation; with continuous oximetry monitoring (per session).’ It is important to note that CPT codes 94625 and 94626 should not be reported in conjunction with CPT codes 94760 and 94761.

3. Procedure

1. During a session of outpatient pulmonary rehabilitation, the healthcare professional provides services aimed at helping the patient improve their respiratory function and overall well-being.
2. The session typically includes curriculum-based education on topics such as self-management and advance care planning, tailored to the patient’s specific needs.
3. The healthcare professional also prescribes exercise based on the patient’s individualized treatment plan, which may involve the use of various exercise equipment such as treadmills, bikes, steppers, upper body ergometers (UBEs), pulleys, and balance boards.
4. Continuous oximetry monitoring is performed throughout the session to measure the patient’s blood oxygen level.
5. The healthcare professional assesses the patient’s outcomes and adjusts the treatment plan as necessary.

4. Qualifying circumstances

CPT 94626 is appropriate for patients with chronic respiratory diseases who require outpatient pulmonary rehabilitation. This code is used when a healthcare professional provides services to help the patient improve their respiratory function and overall well-being. The session must include continuous oximetry monitoring to measure the patient’s blood oxygen level.

5. When to use CPT code 94626

CPT code 94626 should be used when a healthcare professional provides services during a session of outpatient pulmonary rehabilitation that includes continuous oximetry monitoring. It is important to note that this code should not be reported in conjunction with CPT codes 94760 and 94761.

6. Documentation requirements

To support a claim for CPT 94626, the healthcare professional must document the following information:

• Patient’s chronic respiratory disease and the need for outpatient pulmonary rehabilitation
• Specific curriculum-based education provided during the session
• Date and duration of the session
• Exercise prescribed and equipment used
• Continuous oximetry monitoring results
• Patient’s outcomes and any adjustments made to the treatment plan

7. Billing guidelines

When billing for CPT 94626, ensure that the services are provided by a physician or other qualified healthcare professional during a session of outpatient pulmonary rehabilitation that includes continuous oximetry monitoring. It is important to follow payer policies and specific requirements for pulmonary rehab coverage. Do not report CPT 94626 in conjunction with CPT codes 94760 and 94761.

8. Historical information

CPT 94626 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 patient with chronic obstructive pulmonary disease (COPD) participating in a session of outpatient pulmonary rehabilitation that includes continuous oximetry monitoring.
2. A healthcare professional providing curriculum-based education and exercise prescription to a patient with asthma during a session of outpatient pulmonary rehabilitation with continuous oximetry monitoring.
3. A session of outpatient pulmonary rehabilitation with continuous oximetry monitoring for a patient with interstitial lung disease.
4. A healthcare professional monitoring the blood oxygen level of a patient with cystic fibrosis during a session of outpatient pulmonary rehabilitation.
5. A patient with bronchiectasis participating in a session of outpatient pulmonary rehabilitation that includes continuous oximetry monitoring.
6. A healthcare professional providing education and exercise guidance to a patient with pulmonary fibrosis during a session of outpatient pulmonary rehabilitation with continuous oximetry monitoring.
7. A session of outpatient pulmonary rehabilitation with continuous oximetry monitoring for a patient with chronic bronchitis.
8. A healthcare professional monitoring the blood oxygen level of a patient with pulmonary hypertension during a session of outpatient pulmonary rehabilitation.
9. A patient with lung cancer participating in a session of outpatient pulmonary rehabilitation that includes continuous oximetry monitoring.
10. A healthcare professional providing curriculum-based education and exercise prescription to a patient with emphysema during a session of outpatient pulmonary rehabilitation with continuous oximetry monitoring.