Q: Can CPAP/BiPAP be coded under respiratory therapy? We normally code at MDS item O0110G, Non-Invasive Mechanical Ventilator, but not in O0400D, Respiratory Therapy.
A: It is correct that the appropriate place to code the use of BiPAP or CPAP is at MDS item O0110G, Non-Invasive Mechanical Ventilator. Specific instructions can be found in the RAI Manual on page O-6.
As for the respiratory component, Appendix A of the RAI Manual defines Respiratory Therapy in the following way.
“Services that are provided by a qualified professional (respiratory therapists, respiratory nurse). Respiratory therapy services are for the assessment, treatment, and monitoring of patients with deficiencies or abnormalities of pulmonary function. Respiratory therapy services include coughing, deep breathing, nebulizer treatments, assessing breath sounds and mechanical ventilation, etc., which must be provided by a respiratory therapist or trained respiratory nurse. A respiratory nurse must be proficient in the modalities listed above either through formal nursing or specific training and may deliver these modalities as allowed under the state Nurse Practice Act and under applicable state laws.”
In addition to Appendix A requirements, the requirement for coding minutes of respiratory therapy can be found on page O-22 and are as follows.
” Respiratory therapy—only minutes that the respiratory therapist or respiratory nurse spends with the resident shall count towards the 15 minutes per day on one or more days when coding the MDS. This time includes resident evaluation/assessment, treatment administration and monitoring, and setup and removal of treatment equipment. Time that a resident self-administers a nebulizer treatment without supervision of the respiratory therapist or respiratory nurse is not included in the minutes recorded on the MDS. Do not include administration of metered-dose and/or dry powder inhalers in respiratory minutes.”
Given these guidelines, while a CPAP or BiPAP may be a part of a larger respiratory therapy program ordered by a physician and tailored specifically to the resident’s unique, “deficiencies or abnormalities of pulmonary function”, as defined in the Appendix A requirements, simply using such a device, absent of meeting the requirements in Appendix A and page O-22, would not be considered respiratory therapy.
