Indications & Reimbursements
ICD-10-CM Diagnosis Codes: dyspnea and/or dyspnea on exertion are symptoms that may be part of many clinical related to the heart or lung. Therefore, there are many diagnosis codes that may be used when submitting a claim for this service. Please refer to the ICD-10-CM procedure codes below for a list of some of the most commonly used codes used in conjunction with Shape testing. Please recognize these codes are provided as a guide to ICD 10 coding. Referring to LCDs and local private health plan medical policies may be necessary to ensure coverage for specific diagnosis.
The Shape Cardiopulmonary Exercise Testing System is indicated for assessing cardiopulmonary function at rest, during exertion and during recovery from exercise. Testing is done to evaluate functional capacity and to assess the severity and type of impairment of existing as well as undiagnosed conditions. Testing is generally considered clinically indicated for the following conditions:
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To determine whether the patient's exercise intolerance is related to pulmonary disease, cardiac disease, or due to lack of conditioning or poor effort.
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Initial diagnostic workup for symptoms of shortness of breath (dyspnea).
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To determine the extent or degree of abnormalities contributing to shortness of breath.
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To evaluate a patient's response to newly established treatment regimen.
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To determine the need for an dose of ambulatory oxygen.
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To assist in developing a safe exercise prescription for patients with cardiovascular or pulmonary disease.
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To risk stratify patients with cardiomyopathy as to their functional capacity and eligibility for advanced therapies for CHF.
*Q: Does Medicare cover Shape Cardiopulmonary Exercise Testing?
Yes - Coverage for the Shape Cardiopulmonary Exercise Testing System is described in Medicare Local Coverage Determinations (LCDs) issued by regional carriers. These LCDs specifically describe the clinical indications and appropriate diagnoses for services described as Pulmonary Function Testing, Pulmonary Diagnostic Services, or Respiratory Therapy. Refer below for specific examples of these coverage polices.
*Q: Do private health plans cover Shape Cardiopulmonary Exercise Testing?
Yes - Most private health plans follow Medicare coverage guidelines for pulmonary testing. Shape Medical Systems is not aware of any prior authorization requirements for use of the Shape Cardiopulmonary Testing System. Any specific questions about service coverage or payment should be directed to the private health plan.
Frequently Asked Questions
Payment
Both the physician and hospital allowances are national rates that are unadjusted for geographic variances. The allowances apply to services on and after January 1, 2020.
There are four CPT codes that describe the services performed using the Shape System for use in billing physician and hospital outpatient services and one optional, these are:
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94621 Pulmonary Stress Testing, complex; including measurements of CO2 production, O2 uptake, and electrocardiographic recordings.
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94681 Oxygen uptake, expired gas analysis including CO2 output, percentage O2 extracted.
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94690 Oxygen uptake, expired gas analysis, rest, indirect.
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94375 Flow Volume Loop - OPTIONAL; use if performing spirometry prior to exercise.
Use of 94621 requires electrocardiographic recording during the exertion portion of the test. Use of 94681 should be considered when using the Shape System without stress testing (i.e., resting measurements). National Correct Coding Initiatives from CMS only allow one of the three codes to be billed for each patient encounter for use of the Shape System, along with the optional.
ICD-10-CM
Procedure
Codes
ICD-10 CM procedure codes are used by hospitals to bill for inpatient services. When billing for services performed using the Shape System, the most appropriate codes to use are:
