Pediatric Coding Alert

Beginning Jan. 1, 2003, pediatricians can report nebulizer treatments and training sessions with confidence thanks to changes in CPT 2003's pulmonary section. In addition to understanding the revised inhaler codes, pediatric practices should pay attention to changes in the neck repair, venous, hematology and miscellaneous services subsections, which affect procedures they perform. Revised Nebulizer Codes Expand Coverage Pediatric practices have long sought advice regarding how to properly use nebulizer code 94640 (Nonpressurized inhalation treatment for acute airway obstruction) and training codes 94664 (Aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes; initial demonstration and/or evaluation) and 94665 ( subsequent). CPT Codes 2003 alleviates much of this confusion by revising 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]) and 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device) and deleting 94665. Code 94640 now includes pressurized, as well as nonpressurized, treatments for acute airway obstruction. CPT does not restrict these treatments to services for acute airway obstruction, but incorporates sputum induction for diagnostic purposes. The code descriptor includes different treatment methods, such as aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device. You may report these when a nonphysician practitioner, such as a nurse practitioner, provides these services, says Richard Tuck, MD, FAAP, medical director of quality care partners for PrimeCare of Southeastern Ohio in Zanesville, and a member of the American Academy of Pediatrics (AAP) national committee on coding and nomenclature (COCN). Pediatricians should note that 94640 now includes IPPB treatment, which was previously reported 94650-94652. CPT 2003 deletes these codes and includes them in 94640, according to CPT Changes 2003: An Insider's View. CPT Clarifies Multiple Treatments/Trainings CPT 2003 adds a note to 94640 that instructs physicians to append modifier -76 (Repeat procedure by same physician) if they perform more than one treatment on the same date. Although CPT Assistant, April 2000, already stated this, CPT now offers this advice in the manual, alleviating any confusion. Pediatricians can also stop wondering when they should report an initial (94664 for 2002) rather than a subsequent training session (94665 for 2002). CPT 2003 deletes the term "initial" from 94664. The code now refers to any inhaler or nebulizer demonstration. Consequently, CPT 2003 deletes 94665 to remove the distinctions between an initial and subsequent demonstration. You should report only one training session (94664) per day, CPT explains in a note following the code. When office staff under supervision demonstrates how to use an inhaler, charge 94664, says Victoria S. [...]