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Otolaryngology Coding Alert

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Modifier 76 Opens Up Inhalation Payment

Published on Wed Apr 15, 2009

Question: When I bill two units of 94640, insurers deny the second charge. What am I doing wrong? Delaware Subscriber Answer: Instead of billing two units of 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]), the CPT manual instructs you to append modifier 76 (Repeat procedure or service by same physician) for more than one inhalation treatment performed on the same date. If your payer denies the charge with modifier 76, appeal with the CPT manual instructions. If you find that you appeal continually, try to get a meeting with the medical director. You may find that this is an uphill battle as some payers, including some MACs, dont process modifiers 76 and 77 (Repeat procedure by another physician) correctly. They only allow the payment [...]
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