Pediatric Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Should I use 94640 or 94664 for nebulizer treatments? What if I teach the parent how to use it? Louisiana Subscriber   Answer: For a treatment, you should use 94640 (Nonpressurized inhalation treatment for acute airway obstruction). For a patient's first treatment when the initial training is provided, report 94664 (Aerosol or vapor inhalations for sputum mobilization, bronchodi-lation, or sputum induction for diagnostic purposes; initial demonstration and/or evaluation). If the child returns for another treatment with a different adult who also needs training on the nebulizer, you can assign 94664 again. Code 94665 ( subsequent) describes subsequent training with the same patient and adult. You could also report a treatment and a training on the same day with both 94640 and 94664 or 94665, according to CPT Assistant, April 2000. However, because 94664 and 94665 include treatment, many insurance companies will refuse to pay both codes, viewing them as duplicative. So coding experts recommend using modifier -59 (Distinct procedural service) on one of the two codes when billing them together.

Some pediatricians say 94664 is too cumbersome and unclear to use for a combination treatment-training of the nebulizer and prefer a separate training code, 97535 (Self-care/home management training [e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment] direct one-on-one contact by provider, each 15 minutes). They code 94664 and 97535, as well as the E/M and any other services provided during the encounter.

CPT Codes representatives from medical societies have been trying unsuccessfully to get 94664 clarified for months. Until CPT revises the description or issues an updated notice in CPT Assistant, you should select the nebulizer treatment code 94640 for a simple treatment. CPT is looking into including a revision to allow 94664 to be used for training on a nebulizer or a handheld inhaler.