94660

Manipulation chest wall, such as by positive pressure to produce an assistive cough technique, per session

CPT code 94660 describes a therapeutic procedure involving the application of manual or mechanical manipulation to the chest wall to assist a patient in producing a more effective cough and clearing respiratory secretions. This technique, often referred to as 'assistive cough' or 'cough assist,' aims to augment the force of exhalation and cough, thereby facilitating the mobilization and expectoration of mucus from the airways. It is typically performed when a patient's natural cough mechanism is impaired or insufficient to clear secretions, often due to neuromuscular weakness or other respiratory conditions. The service is reported per session.

Clinical Indications

  • Neuromuscular diseases (e.g., muscular dystrophy, amyotrophic lateral sclerosis, spinal muscular atrophy, spinal cord injury) leading to impaired respiratory muscle strength and ineffective cough.
  • Patients with chronic respiratory conditions (e.g., cystic fibrosis, bronchiectasis) experiencing acute exacerbations with excessive and tenacious secretions that cannot be cleared effectively by spontaneous cough.
  • Post-operative patients with retained secretions, atelectasis, or risk of pneumonia due to an inability to cough forcefully.
  • Any condition resulting in a weak or non-productive cough where secretion retention leads to respiratory compromise, recurrent infections, or risk of airway obstruction.

Procedure Steps

  1. Patient assessment: Evaluation of the patient's respiratory status, cough effectiveness, secretion burden, and tolerance for the procedure.
  2. Patient positioning: Position the patient appropriately (e.g., supine, side-lying, or sitting) to optimize chest wall access and respiratory mechanics for the intervention.
  3. Patient instruction: Instruct the patient on the technique, typically involving deep inhalation followed by an attempt to cough.
  4. Chest wall manipulation: Apply manual pressure to the chest wall, often over the diaphragm or lower rib cage, synchronized with the patient's exhalation and attempted cough, to enhance the force of the cough. Mechanical devices providing positive pressure may also be used.
  5. Secretion clearance: Encourage the patient to expectorate loosened secretions.
  6. Repetition: Repeat the technique as necessary throughout the session, monitoring patient tolerance and effectiveness of secretion clearance.
  7. Post-procedure assessment: Re-evaluate respiratory status, auscultate lung fields, and assess the quantity and character of expectorated secretions.

Coding Guidelines

  • CPT code 94660 is billed per session, regardless of the duration within that session.
  • This code should be reported for services involving specific chest wall manipulation to assist a cough, not for general chest physiotherapy techniques like percussion and postural drainage, which are typically coded separately (e.g., 94667 or 94668).
  • Documentation must clearly describe the specific technique used, the medical necessity for the assistive cough maneuver (e.g., ineffective cough due to underlying condition, presence of secretions), and the patient's response to the treatment.
  • This service is typically performed by a physician or other qualified healthcare professional, such as a physical therapist or respiratory therapist, under the order and supervision of a physician.
  • Ensure that the service provided is distinct from other respiratory therapies performed on the same day to avoid unbundling issues.

Associated ICD-10 Codes