Otolaryngology Coding Alert

Question: May an otolaryngologist's office bill methacholine in addition to the bronchospasm test? Also, may I report nebulizer supply, such as the mask, mouthpiece and tubing with a nebulization?


Georgia Subscriber


Answer: The answer is yes and no; Yes, you should code the medication in addition to the bronchospasm test (revised for 2005: 94070, Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents [e.g., antigen[s], cold air, methacholine). No, you shouldn't bill a mask (A7015, Aerosol mask, used with DME nebulizer) or mouthpiece (A4617) and tubing (A4616, Tubing [oxygen], per foot) with a nebulization (94640, Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device). 

Why: The practice expense (PE) for all codes include any supply intrinsic in the procedure. Because you always use a mask or mouthpiece and tubing with nebulization, 94640's payment includes the related equipment.

Medicine, on the other hand, isn't inherent in a code. The physician must adjust the dose based on patient need. Therefore, you may separately bill the appropriate J code in addition to the pulmonary code.

CPT's rationale on 94070's changes makes this clear. "The supply of the ... antigen[s] should be reported with 99470 or appropriate HCPCS supply code[s]." The new HCPCS code, effective Jan. 1, for methacholine is J7674 (Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg).

For the nebulizer medication albuterol (Ventolin, Proventil) or levalbuterol (Xopenex), report:
  concentrated forms - J7618 (Albuterol, all formulations including separated isomers, inhalation solution administered through DME, concentrated form, per 1 mg [Albuterol] or per 0.5 mg [Levalbuterol]).
  premixed or unit-dose forms - J7619 (Albuterol, all formulations including separated isomers, inhalation solution administered through DME, unit dose, per 1 mg [Albuterol] or per 0.5 mg [Levalbuterol]).