Pediatric Coding Alert

Although CPT 2003 clarified the nebulizer training codes, pediatricians are still asking questions on how to report nebulizer sessions. By understanding how to code each service and recognizing that payer policies vary, you can bill these procedures and services with confidence. Pediatricians often treat children for wheezing and difficulty breathing due to asthma, lung disorders or upper respiratory infections. These office visits can take a lot of time because they encompass many services, including patient history, examination and medical decision-making, and procedures such as spirometry, bronchodilation and training. Part 1 of this article focuses on the initial procedures. For nebulizer training and E/M coding issues, see part 2 in February's Pediatric Coding Alert. Understand a Typical Session During a typical session, a patient presents to a pediatrician's office for wheezing (786.07 ). The physician reviews the patient's history and examines the patient, concentrating on the lungs, upper airways, eyes, ears, nose (particularly the nasal passages) and throat.

The physician cannot evaluate the airways from the examination alone, so he performs pulse oximetry and uses a spirometer to measure pulmonary function. He administers a bronchodilator to the patient, followed by another pulse oximetry measurement and spirometry. He then compares the before and after readings to assess the bronchodilator's success. The patient continues to exhibit respiratory symptoms, so the pediatrician administers a second bronchodilation followed by spirometry. The pulmonary reading shows that the patient's symptoms are subsiding. The pediatrician prescribes an inhaler and a spacer for the child. A nurse demonstrates to the child and parent how to use the inhaler. The pediatrician and nurse perform seven procedures:
pulse oximetry x 2 spirometry before and after bronchodilation spirometry bronchodilation x 2 training; and one service: an established patient office visit. Bill for Pulse Oximetry Coverage for pulse oximetry (94760, Noninvasive ear or pulse oximetry for oxygen saturation; single determination) depends on the payer. Medicare announced in January 2000 that it would no longer cover 94760 unless it is the only procedure provided. This means that if you bill any other code on that day, you cannot bill pulse oximetry as well because Medicare has bundled the oximetry codes into every other CPT code. If you perform pulse oximetry and nothing else, that is the only time you can bill and get paid for this procedure.

Carriers view pulse oximetry as similar to taking a patient's temperature. "Pulse oximetry is no more invasive and arguably less invasive than recording the patient's temperature, another example of a diagnostic service for which we do not make separate payment," according to Medicare's announcement. "If interpretation of pulse oximetry or temperature data is complex, then that interpretation is clearly part of the medical decision-making included in [...]