52 ICD-10 HCPC Codes for HFCWO Therapy

The saying, “one for all, and all for one” made popular from the French novel, The Three Musketeers, is a nice thought but it is unrealistic in healthcare as one treatment cannot solve everything.  But there is one therapy option that comes close when talking about the need for airway clearance therapy.

Discussions about airway clearance for respiratory health in most articles and clinical papers speak in generalities about airway clearance – it is “for a variety of conditions” or it just focuses on one or two conditions.  Well, it is time to be specific.

Did you know there are 52 Medicare approved ICD-10 codes for one therapy – High Frequency Chest Wall Oscillation (HFCWO) airway clearance therapy vests fall under the E0483 HCPCS and require a doctor’s prescription for use.1  HFCWO therapy is designed to reduce mucus build up.  This therapy is administered by a vest the patient wears daily, typically for 20 – 30 minutes at least once a day, that can help loosen thick, mucus secretions so it can be mobilized from the lungs by coughing. Clearing the airways may help decrease lung infections, reduce antibiotic use and hospitalization, and improve lung function. The HCPCS code associated with HFCWO therapy is EO483.1

We all know Medicare does not like to spend money on unnecessary medical treatments, so if they have 52 approved conditions for this one therapy there must be a reason — and it is simply that HFCWO therapy can help in many medical conditions. So why is HFCWO therapy not a prominent treatment?

  • Is it because airway clearance therapy is underutilized?
  • Is it because it is only one of many airway clearance therapy options?
  • Is it because it is one of the more expensive airway clearance therapy options?

The therapy is underutilized.2 There are many options to choose from for airway clearance, but the therapy choice needs to be personalized for the patient to drive towards better adherence.3

It is more expensive compared to the other options, but it is approved by Medicare and most private insurances.  These reasons are all true, but it shouldn’t be this way because there are millions of people out there right now suffering from poor lung function and quality of life with a greater risk of morbidity and mortality caused by bronchiectasis (BE), cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD), asthma, and neuromuscular diseases or conditions.

It is time to look a little deeper at some of the ICD-10 codes to understand the different conditions and needs for HFCWO therapy. Cystic Fibrosis is associated with endocrine and metabolic conditions – the E codes.  Airway clearance is necessary for this disease, and it is emphasized.  But there is still documentation that not all patients/caregivers partake in treatment as often as prescribed. This is an opportunity to find the right airway clearance option that fits the patient and caregiver’s lifestyle.

Respiratory conditions, the J codes, like bronchiectasis and disorders of the diaphragm are underdiagnosed or can be misdiagnosed. In the COPD patient population airway clearance is paramount for disease management. Studies indicate that 42% of COPD patients could have bronchiectasis.4 Most of the COPD population also has hyperinflation of the lungs which is a disorder of the diaphragm.5 Why is it so confusing? Because the symptoms associated with COPD, bronchiectasis and asthma are similar and the clinical overlap between these conditions can easily contribute to diagnostic errors.6 There is actually a new condition called Asthma COPD Overlap Syndrome (ACOS) that addresses patients with overlap symptoms which leads to an exponentially worse overall health and quality of life compared to patient’s diagnosed with only one condition.7

The nervous system conditions, the G codes, like multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS) and muscular dystrophy (MD) can be deadly due to the consequences of an ineffective cough. Atelectasis, mucus plugging, and recurrent respiratory tract infections are the main factors of morbidity and mortality in neuromuscular diseases.

Studies show HFCWO therapy is safe, tolerable and provides better compliance, compared to standard chest physiotherapy, in patients with neuromuscular diseases.  Medical costs also decreased after initiation of HFCWO along with inpatient admission costs and pneumonia costs in this patient population.8

Airway clearance therapy is a cornerstone treatment aimed at minimizing the effects of airway obstruction, inflammation, and infections in numerous lung conditions like some we just discussed.  If the airway obstruction – or mucus – is not cleared, then the endless cycle of inflammation and infection cannot be stopped.  Airway clearance therapy can help break this cycle and reduce overall healthcare costs as well.

When it comes to respiratory health there is a need to keep pushing for an “all for one” mentality to assess and treat the condition or disease for the individual patient with the goal of better lung function and quality of life.

AffloVest® is a proven high frequency chest wall oscillation (HFCWO) therapy designed to provide patients the freedom and mobility to customize and enhance airway clearance therapy, help mobilize lung secretions, and promote treatment adherence for patients with bronchiectasis, CF, COPD, MS, MD , ALS, and other neuromuscular and respiratory diseases.

The AffloVest also requires a doctor’s prescription for treatment by HFCWO. The AffloVest has received the FDA’s 510k clearance for U.S. market availability, and is approved for Medicare, Medicaid, and private health insurance reimbursement under the Healthcare Common Procedure Coding System (HCPCS) code E0483 – High Frequency Chest Wall Oscillation. The AffloVest is available through the U.S Department of Veterans Affairs/Tricare. Patients must qualify for coverage and meet their individual insurance’s eligibility requirements.

This article is meant to offer general coverage information, coding and payment information for prescriptions associated with use of HFCWO vest therapy. This article is based on the medical necessity of the services and supplies provided, the requirements of insurance carriers and any other third-party payers, and any local, state or federal laws that apply to the products and services rendered. Given the constant change in public and private reimbursement coverage, we do not guarantee the accuracy or timeliness of this information.

References:

  1. Medical Billing and Coding https://www.medicalbillingandcoding.org/icd-10-cm/
  2. O’Neill, K. et al. Airway Clearance, Mucoactive Therapies and Pulmonary Rehabilitation in Bronchiectasis. Volume 24, Issue 3, Pages 227-237.
  3. Volsko, T. Airway Clearance Therapy: Finding the Evidence. Respiratory Care. Volume 58, Issue 10, Pages 1669-78.
  4. Kosmas E, et al., Bronchiectasis in Patients with COPD: An Irrelevant Imaging Finding or a Clinically Important Phenotype? CHEST 2016.
  5. Gagnon, P. et al. Pathogenesis of Hyperinflation in Chronic Obstructive Pulmonary Disease. International Journal of COPD. 2014.
  6. Aksamit, T. et al. Bronchiectasis and Chronic Airway Disease: It is not just about Asthma and COPD. CHEST Journal. October 2018
  7. Papaiwannou A, Zarogoulidis P, Porpodis K, et al. Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS): current literature review. J Thorac Dis. 2014;6 Suppl 1(Suppl 1):S146-S151.
  8. Chatwin, M. et al. Airway Clearance Techniques in Neuromuscular Disorders: A State of the Art Review. Respiratory Medicine (2018). Volume 136. Pages 98-110.
  9. Ford et al., Total and State-Specific Medical and Absenteeism Costs of COPD Among Adults Aged 18 Years in the United States for 2010 and Projections Through 2020; CHEST American College of Chest Physicians; CDC; 2014.
  10. Weycker D., et al., Prevalence and Economic Burden of Bronchiectasis. Clinical Pulmonary Medicine. 2005;12:205.
  11. McShane, P. et al., Concise Clinical Review Non-Cystic Fibrosis Bronchiectasis; University of Chicago Medicine, Chicago, Illinois; University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; Am J Respir Critical Care Medicine. Volume 188, Issue. 6, Pages 647–656, September 2013.