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Pulmonary rehabilitation services benefit patients with chronic lung disease by reducing symptoms and restoring independent function. With a multidisciplinary approach to individual patient care through education, exercise, and psychosocial interventions, health-care costs and utilization may be reduced. While pulmonary rehabilitation services have typically been provided in a facility setting, many respiratory care services can be safely provided and appropriately reimbursed in the outpatient physician office setting, with appropriate physician supervision. After reviewing the utility of pulmonary rehabilitation for patients with chronic lung disease, the supervision, documentation, coding, and reimbursement requirements for providing rehabilitative respiratory care services in the outpatient office setting are detailed.
(CHEST 2006; 129:169-173)
Key words: coding; documentation; physician office; pulmonary rehabilitation
Abbreviations: CPT = current procedure terminology; RCP = respiratory care practitioner
Pulmonary rehabilitation is now considered to be a mainstay of treatment for patients with chronic lung disease. The goals of pulmonary rehabilitation are to reduce symptoms, improve activity and daily functioning, and restore the highest level of independent functioning in patients with respiratory disease.1 Key elements include a multidisciplinary approach to care with a focus on the individual patient through education, exercise, and psychosocial interventions. Appropriate candidates for pulmonary rehabilitation are symptomatic patients with chronic lung disease who are aware of their disability and are motivated to participate actively in their health care. They include not only patients with COPD but also those with restrictive lung disease (eg, interstitial, alveolar, pleural-basecl, and neuromuscular types) and cystic fibrosis.
Pulmonary rehabilitation has been shown to result in many benefits, including improvements in exercise performance, reduction of dyspnea, improvement in health-related quality of life, and reduction in health-care utilization.1-7 A recent multicenter, community-based experience" (known as the California Collaborative) included nine centers enrolling a total of 647 patients, and showed consistent benefits in dyspnea and quality of life as well as a reduction in health-care utilization (eg, physician visits, telephone calls, hospital days, and urgent care visits) over an 18-month follow-up period. In the recent National Emphysema Treatment Trial,9 a study of lung volume reduction surgery by the National Institute of Health and the Centers for Medicare and Medicaid Services, pulmonary rehabilitation was included as part of the standard care for patients who were enrolled in the trial.
According to the Global...