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It has become clear, over the last 10+ years, the critical importance of good airway clearance of secretions as respiratory muscles become weaker, particularly for people with neuromuscular diseases (but also for people with intrinsic lung disease as they become weaker). The importance of both the expiratory muscles as well as the inspiratory muscles needs attention. Effective assisted cough techniques should be taught early, certainly when peak cough flow (PCF) falls below 300 lpm. Both breath stacking, to increase inspiratory capacity, and assisted cough flow are needed. When manual methods are not sufficient, then the CoughAssist made by Phillips/Respironics (previously called the In-Exsufflator), should be used to ensure a good PCF. In the past reimbursement had been a barrier. Now CMS (Centers for Medicare & Medicaid Services) has created a new HCPCS code for Medicare to reimburse for the Cough Assist device when it is clinically appropriate. Most health plans and health insurance companies follow Medicare policies for those covered for medical equipment. The information below summarizes the details. Ventilator users and their caregivers should become familiar with this information.
With all best wishes,
Edward Anthony Oppenheimer, MD, FCCP
Cough stimulating device: Medicare HCPCS code E0482
The CoughAssist: This is a device that helps patients who cannot cough for themselves. It enhances or replaces a patient's natural removal of bronchial secretions. The noninvasive device simulates a natural coughing process and reduces the risk of airway damage and respiratory complications associated with more invasive procedures.
The CoughAssist assists patients in clearing secretions by gradually applying positive pressure to the airway to achieve a good inspiratory lung volume, and then cycling rapidly to negative pressure to achieve effective expiratory cough flow. This rapid shift in pressure, via a mask, mouthpiece, or artificial airway, produces a high expiratory flow rate from the lungs, which simulates a cough.
Phillips/Respironics now offers five different sizes of masks and a tracheostomy adapter. These part numbers are accessible at Respironics.
The CoughAssist is a revised model of the Emerson In-Exsufflator, based on the Cofflator (O.E.M Corporation). The CoughAssist (or In-Exsufflator) is a portable electric device which utilize a blower and a valve to alternately apply a positive and then a negative pressure to a patient's airway in order to assist the patient in clearing retained bronchopulmonary secretions. Air is delivered to and from the patient via a breathing circuit incorporating a flexible tube, a bacterial filter and either a facemask, a mouthpiece, or an adapter to a tracheostomy or endotracheal tube.
The CoughAssist is indicated for use by patients who are not only unable to cough, but also unable to clear secretions effectively using available manual cough assistive techniques. This patient population experiences reduced peak cough expiratory flow (PCF) resulting from high spinal cord injuries, neuromuscular deficits or severe fatigue associated with intrinsic lung disease.
Contraindications for the CoughAssist: history of bullous emphysema, susceptibility to pneumothorax or pneumomediastinum (lung barotrauma injury). People with cardiovascular instability should be cautious, and if the CoughAssist is used it should probably initially be used with professional observation at a medical center with at least oximetry monitoring of heart rate and oxygen saturation, before use in the home.
Published studies are available. Information available on the Internet includes the Respironics website.
Respironics has information and tips on their website; also your physician or equipment company can contact their reimbursement services staff (800-345-6443 or 800-659-9235).
"Helpful Hints" for filing a physician's statement of medical necessity to support coverage for the CoughAssist — (modified from Respironics):
Other Airway Clearance Devices
Some other airway clearance devices (these are not covered by this HCPCS code):
References and additional information regarding the CoughAssist, including reimbursement information, usage protocol, and requests for an introduction and training CD, may be obtained by contacting the Respironics (800-345-6443). Or your physician can contact your regional DMERC Medical Director.
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