ED Coding and Reimbursement Alert

Question: Is it true that if the physician performs continuous inhalation treatment (94644) for less than an hour that we can report 94640? We can't find any CMS directives on this topic.

Codify Subscriber

Answer: In absence of CMS guidance, you should look to the AMA's instructions in the CPT^® manual, as well as the corresponding specialty society, for advice. CPT^® notes the following:

• 94640 – Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device.○○(For more than 1 inhalation treatment performed on the same date append modifier 76)
• (Do not report 94640 in conjunction with 94060, 94070 or 94400)
• 94644 – Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour○(For services of less than 1 hour, use 94640)

Because of the parenthetical note below 94644, you are free to report 94640 for inhalation services that last less than an hour. Keep in mind, however, that most payers will not reimburse 94640 in the facility setting, so it would be rare to report this code in an emergency department.

This the American Association of Respiratory Care, which publishes the following document on its website: https://www.aarc.org/wp-content/uploads/2014/10/aarc-coding-guidelines.pdf.