Primary Care Coding Alert

Family practice coders struggle with how to report several nebulizer encounter codes  and say unclear verbiage is the primary cause of the confusion. Three codes in particular puzzle coders, who note that fuzzy definitions often lead to miscoding and may result in lower reimbursements.   The chief offenders are:   " 94640 (nonpressurized inhalation treatment for acute airway obstruction),   " 94664 (aerosol or vapor inhalations for sputum mobilization, bronchodilation or sputum induction for diagnostic purposes; initial demonstration and/or evaluation), and   " 94665 (& subsequent).    Despite the confusion over CPT s language, there are a few twists within these code definitions that distinguish them, explains Carol Pohlig, BSN, RN, CPC, a reimburse-ment analyst for the office of clinical documentation in the department of medicine at the University of Pennsylvania in Philadelphia.  There are specific circumstances when one, but not the other, should be assigned.   Assign 94640 for Treatment of Acute Episodes   When a patient has trouble breathing and receives a nebulizer treatment in the office, coders would assign 94640.  This code is exclusively used for treatment of acute episodes, Pohlig says.   For instance, a 36-year-old woman with a history of asthma and allergies suffers an acute flare-up. She comes into the office and is nebulized. Coders should report 94640 with a diagnosis code of 493.00 (extrinsic asthma, without mention of status asthmaticus). The office visit is also reported using the appropriate E/M code and attaching modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).   The treatment may need to be repeated during the visit, and each treatment should be reported with 94640. Modifier -76 (repeat procedure by same physician) should be appended to each subsequent code.   Although asthma is a common condition requiring the treatment as reflected in 94640, it is not the only condition that prompts nebulization.  Treatment may be given for any acute airway obstruction, she notes.  The term  obstruction in the definition doesn t mean there is a foreign body lodged in the airway. It refers to any condition that prevents air from flowing in and out of the lungs freely. For instance, the bronchial airway may be swollen because of infection and that constitutes an obstruction. Croup (464.4), for example, may require a nebulizer treatment.   The reference to  nonpressurized in the definition for 94640 is important as well, Pohlig explains, because it differentiates this treatment from similar therapies in the pulmonary section of CPT (e.g., 94650, intermittent positive pressure breathing [IPPB] treatment, air or oxygen, with or without nebulized medication; initial demonstration and/or evaluation, would not [...]