R06.4 — Hyperventilation
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
- Diagnostic test claims must include the test result if known; if result is not available, report the symptoms that prompted the test.
- The patient medical record must include the ordering provider's assessment related to the patient's complaint, relevant medical history, and results of pertinent tests/procedures.
- Office visit records and operative reports must be signed and dated; all services ordered or rendered to Medicare beneficiaries must be signed.
Key Coverage Criteria
- For services that require a referring or ordering physician, the claim must report the referring/ordering physician's name and NPI.
- Claims must include a valid ICD-10-CM diagnosis code that best describes the patient's condition for which the service was performed; otherwise the claim will be returned as incomplete under SSA Section 1833(e).
- For diagnostic tests, the claim should report the test result if known, otherwise report the symptoms that prompted the test.
- If a service is likely to be non-covered, an Advance Beneficiary Notice (ABN) may be used and the appropriate modifier (GA, GX, GY, or GZ) should be appended to the claim as applicable.
- Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
- Therapeutic respiratory procedures (HCPCS G0237, G0238, G0239) using an individualized physical conditioning and exercise program with breathing techniques are covered for patients with documented activity limitations.
17 Active Policies
L34636 — Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)
J05
A57476 — Billing and Coding: Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)
J05
A57205 — Billing and Coding: Oximetry Services
J12
L35434 — Oximetry Services
J12
Related Codes
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