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Resolved Two charges of 94660 on hospital bill

RosieB_20036

New member
First of all I would like to thank CCO for helping me pass my CPT exam! You guys are the best!

I hope this question is allowed as this is for my recent hospital stay.

I was admitted to the hospital on 4/29/22 to 5/1/22 for treatment for Atrial Fibrillation. It started when my family doctor seen me for increased heart rate and performed an Electrocardiogram on me. My heart rate was 180 bpm and in AFIB. He then sent me home to pack for a two nights to be admitted to the hospital. When I arrived at the hospital and was taken to my room, I unpacked my personal bipap machine (I've been using a bipap since 2009 for obstructive sleep apnea) and the nurse asked me if I needed any assistance with my bipap. I told her I just needed distilled water for the humidifier. She then brought me a bottle of sterilized water. And that was the extent of their interaction with me on my bipap, the remaining of my visit was just to address my afib and get my heart back into a good sinus rhythm. I was never given any oxygen or other respiratory assistance while in the emergency room or during my hospital stay.

Once I received my hospital bill I noticed there were two charges of $1,419 on my bill for code 94460 and I'm wondering how they can charge me for this when they did nothing as far as cpap or respiratory therapy for me.
From the bill:
Respiratory Services
$2,838.00
Hc Cpap Therapy Init And Mgmt - 94660 (CPT®)
$1,419.00
Hc Cpap Therapy Init And Mgmt - 94660 (CPT®)
$1,419.00

Radiology - Diagnostic
$297.00
Hc Dx Chest 1 View - 71045 (CPT®)
$297.00


Also they charged for the CT scan that they were unable to perform because the emergency department nurse inserted the port for the contrast wrong and the contrast went into the tissue/muscle of my arm instead of into the vein so they could not perform the CT. They have since reschedule the CT w/contrast for next week.

Can anyone tell me if they can charge me for this? I've attached a pic of my bill.
 

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Jesus

Chief Operations Officer
Staff member
I'll let Alicia chime in, but from what I can see, that 94660 doesn't even make sense.

CPT code 94660 is a face-to-face service addressing the use of CPAP for sleep-disordered breathing, such as (but not limited to) obstructive sleep apnea. This may often be performed in a sleep testing laboratory. CPT code 94660 requires that the physician personally perform face-to-face patient care, such as fitting the mask and titrating pressure. There is respiratory therapist work and practice expense, in addition to the physician's phoning in orders and signing forms.

Let's see what Alicia says.

Source
 

RosieB_20036

New member
I'll let Alicia chime in, but from what I can see, that 94660 doesn't even make sense.



Let's see what Alicia says.

Source
Thanks for your reply. I've attached a pic of the bill. I tried uploading earlier but for some reason I kept getting an error message. I only expanded some of the charges as there were way to many under 'Laboratory' and 'Pharmacy' to fit on one page. I didn't understand the charges either as I was being treated for AFIB and nothing to do with my sleep apnea. I only brought my BiPap machine with me because my primary doctor said I would most likely be admitted for two nights and would need it while I sleep.
 

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Alicia

Director of Education
Staff member
Rosie you are not alone in this. It happens all the time. Also, this is when your education will pay off in more ways then you though.
1. Note that the nurse documents but the hospital coder is the one who pulls the codes. OR they are using an AI system that pulls from key words. Not your nurse.
2. You need to contact the hospital in writing and call with your MRN#, dates of stay and codes/charges you are disputing. State that these services were not provided.
3. Keep in mind that "Intent" is what is being billed however if say a scan can NOT be preformed then they need to be using a modifier etc. to explain why it was not completed as ordered by the provider.

We would love to be able to use this as an example in the future for a case study if you can give us permission. All your personal information will be witheld. Now you know why insurance companies are so picky and stingy. It is actually Fraud and Abuse. Those sesrvices were NOT performed. Yet you and the payer are sent the bill.
 

RosieB_20036

New member
Rosie you are not alone in this. It happens all the time. Also, this is when your education will pay off in more ways then you though.
1. Note that the nurse documents but the hospital coder is the one who pulls the codes. OR they are using an AI system that pulls from key words. Not your nurse.
2. You need to contact the hospital in writing and call with your MRN#, dates of stay and codes/charges you are disputing. State that these services were not provided.
3. Keep in mind that "Intent" is what is being billed however if say a scan can NOT be preformed then they need to be using a modifier etc. to explain why it was not completed as ordered by the provider.

We would love to be able to use this as an example in the future for a case study if you can give us permission. All your personal information will be witheld. Now you know why insurance companies are so picky and stingy. It is actually Fraud and Abuse. Those sesrvices were NOT performed. Yet you and the payer are sent the bill.
Thank you for your response, Alicia! I had a feeling I was right in that they should not be charging me for services not performed. I have requested a complete medical record from the provider as well. I will be sending in the letter to dispute these charges as soon as possible.
Also, I would be honored for you to use this as an example for a case study. :)
 

RosieB_20036

New member
Rosie you are not alone in this. It happens all the time. Also, this is when your education will pay off in more ways then you though.
1. Note that the nurse documents but the hospital coder is the one who pulls the codes. OR they are using an AI system that pulls from key words. Not your nurse.
2. You need to contact the hospital in writing and call with your MRN#, dates of stay and codes/charges you are disputing. State that these services were not provided.
3. Keep in mind that "Intent" is what is being billed however if say a scan can NOT be preformed then they need to be using a modifier etc. to explain why it was not completed as ordered by the provider.

We would love to be able to use this as an example in the future for a case study if you can give us permission. All your personal information will be witheld. Now you know why insurance companies are so picky and stingy. It is actually Fraud and Abuse. Those sesrvices were NOT performed. Yet you and the payer are sent the bill.
Good morning Alicia! So I received my medical records today and, although it was a long record, the only references I found to the cpap/bipap are the ones listed in the screenshots below. As I said earlier in my post, the only thing they did for me as far as my bipap is concern is when I was transferred into a room, from the ER, and was unpacking my bipap machine to place on the nightstand. They asked if I needed any assistance and I stated that I just needed distilled water for the humidifier.

I've attached screenshots from the medical record they sent me and have cut off the right side to protect names of hospital staff.

Looking at these notes, does this give them permission to code for these charges on my bill?
Respiratory Services:
$2,838.00
Hc Cpap Therapy Init And Mgmt - 94660 (CPT®)
$1,419.00
Hc Cpap Therapy Init And Mgmt - 94660 (CPT®)
$1,419.00


I never had a Nasal Cannula or any other devices to deliver oxygen placed during my whole stay there, in the Emergency Department or in my patient room. I wasn't having any issues with breathing just issue with my heart rate. My husband was with me the entire time and I also Facetime my 3 adult daughters many times while in the ED and during my 2 night stay in the room, they also saw that I never had a nasal cannula or other respiratory device throughout my visit.

I never saw anyone for a Respiratory Evaluation


Alicia could you please guide me on how I should proceed with this matter? Thank you so much for your help!
 

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Jesus

Chief Operations Officer
Staff member
This is getting tricky to advise on without drifting into legal territory. Remember we are not lawyers and are not offering legal advice.

Here's what I think happened from a practical standpoint.

You went in with a special medical device that the normal public doesn't typically use. It's possible that by actively using that device, you created an environment where you had to be monitored by a doctor for that condition. This could have resulted in those charges for both days of monitoring. They're technically liable for your care while you're there and you possibly opened up a new dimension of care with the machine present.

Now, that said, it doesn't seem to be billed correctly as the code suggests. In that case, you could dispute the code itself by saying a physician was not present, cannulas were not used, etc. You can dispute every charge you find questionable.

Your first point of dispute would be the hospital billing department. Words like "filing a dispute" or "grievance" might trigger the right investigation. You should also call your health insurance and give them a heads up because they have lawyers on hand to help prevent mistakes that cost them money. It's very possible they can get things fixed much faster than the hospital billing team. Your final point of escalation would be the state. You'll need to contact your state for escalation phone numbers but this is a good start.

Good luck!

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