Chest Physiotherapy (first session)

What it is

Mucus that will not come up is a mechanical problem, and chest physiotherapy is a mechanical answer to it. The lungs are divided into segments that drain in different directions, so the patient is placed in a specific position — head down, on one side, face down, propped at an angle — chosen so that gravity works on the segment that needs clearing. While they are in that position, a therapist claps a cupped hand rhythmically against the chest or back over that segment, or applies vibration, which jars thickened secretions loose from the airway walls. Then the patient coughs, and what has been loosened comes up.

What this particular code describes is the first session: the therapist working out which segments matter for this patient, demonstrating the positions and the percussion technique, and assessing how the patient tolerates and responds to it. Chest physiotherapy is usually done at home, several times a day, by the patient or a family member — so the teaching is the point, and the code exists because that first visit is a different piece of work from the routine sessions after it.

Why it is done

• To clear mucus from the airways in conditions where secretions are thick or too plentiful to clear by coughing alone, such as cystic fibrosis
• To help re-expand or clear a section of lung in bronchitis and other conditions where mucus has plugged an airway
• To teach a family member or caregiver a technique they will be performing daily at home, including where on the chest to clap and where not to
• To evaluate whether a patient tolerates the positions and the percussion well enough for this to be a workable part of their routine

What to expect

The session is done with an empty stomach where possible — before a meal, or well after one — because the head-down positions are uncomfortable on a full one. You will be moved through several positions and held in each for several minutes, with percussion over the relevant area for a few minutes at a time, and asked to cough in between. The clapping sounds louder than it feels; it should not hurt, and should be done over ribs rather than over the spine, the breastbone or bare skin. Expect to be coughing productively during and after. Most people leave with written positions and a schedule.

Questions worth asking

• Is this taught by a respiratory therapist, a physical therapist or a nurse, and does that affect how it is billed?
• Are the follow-up sessions billed under a different code and price than this initial one, and how many are expected?
• If a mechanical vest or percussion device is recommended instead of hand percussion, is that billed as durable medical equipment through a separate supplier?
• If a family member is being trained rather than me, is the session still billed under my name and applied to my deductible?