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Pediatric Coding Alert

Reader Question:

Who Can Teach Nebulizer Use?

Published on Fri Sep 28, 2007

Question: Can we bill for nebulizer teaching that a certified medical assistant (CMA) or licensed practical nurse (LPN) performs, or does a physician or other provider have to do the teaching? Kentucky Subscriber Answer: A CMA or LPN may perform the instruction and evaluation described in 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device). Catch: When a nurse or medical assistant shows a patient how to use a nebulizer and/or evaluates a patient's use of the device, you should bill 94664 incident-to the on-duty pediatrician. Therefore, make sure you meet the insurer's incident-to guidelines, which may follow Medicare's that require the pediatrician: provide direct supervision (be present in the office suite) throughout the procedure establish the treatment plan of care countersign the CMA's or LPN's separate note documenting the instruction. (For a useful tool that supports 94664, see "Prove Your RN Did 94664" at left.)
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