How To Use HCPCS Code E0471

HCPCS code E0471 describes a respiratory assist device with bi-level pressure capability, used with a noninvasive interface such as a nasal or facial mask. This device is commonly referred to as an intermittent assist device with continuous positive airway pressure (CPAP) device. It is used to provide respiratory support for patients who have difficulty breathing on their own.

1. What is HCPCS E0471?

HCPCS code E0471 is used to identify a specific type of respiratory assist device. It is designed to deliver bi-level pressure to the patient’s airway, providing support during inhalation and exhalation. The device is used with a noninvasive interface, such as a nasal or facial mask, which allows the patient to receive the necessary airflow without the need for invasive procedures.

2. Official Description

The official description of HCPCS code E0471 is “Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device).” The short description is “Enteral supp not otherwise c.”

3. Procedure

1. The healthcare provider will assess the patient’s respiratory needs and determine if a respiratory assist device is necessary.
2. If the provider determines that a bi-level pressure device is appropriate, they will select the appropriate device and interface, such as a nasal or facial mask.
3. The provider will fit the patient with the selected interface and ensure it is properly secured.
4. The provider will set the device to deliver the appropriate bi-level pressure, taking into account the patient’s specific respiratory needs.
5. The patient will be instructed on how to use the device and interface properly, including how to adjust settings if needed.
6. The provider will schedule follow-up appointments to monitor the patient’s progress and make any necessary adjustments to the device settings.

4. When to use HCPCS code E0471

HCPCS code E0471 should be used when a healthcare provider prescribes a respiratory assist device with bi-level pressure capability, along with a noninvasive interface, for a patient who requires respiratory support. This code is typically used for patients with conditions such as sleep apnea, chronic obstructive pulmonary disease (COPD), or other respiratory disorders.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code E0471, healthcare providers should ensure that the following documentation is included:

• A detailed description of the patient’s respiratory condition and the medical necessity for the device
• The specific device and interface used
• The settings and adjustments made to the device
• The patient’s response to the device and any changes in their respiratory status

6. Historical Information and Code Maintenance

HCPCS code E0471 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code E0471 is eligible for coverage by Medicare. The pricing indicator code for this code is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, which means it is not applicable as HCPCS priced under one methodology. Healthcare providers should check with individual insurance carriers to determine coverage and reimbursement rates for this code.

8. Examples

Here are five examples of when HCPCS code E0471 should be billed:

1. A patient with severe sleep apnea requires a respiratory assist device with bi-level pressure capability and a nasal mask for nightly use.
2. A patient with COPD needs a respiratory assist device with bi-level pressure capability and a facial mask to help improve their breathing during the day.
3. A patient with neuromuscular disease requires a respiratory assist device with bi-level pressure capability and a nasal mask to support their breathing while sleeping.
4. A patient with obesity hypoventilation syndrome needs a respiratory assist device with bi-level pressure capability and a facial mask to assist with their breathing at night.
5. A patient with respiratory failure requires a respiratory assist device with bi-level pressure capability and a nasal mask to provide continuous respiratory support.