Primary Care Coding Alert

Question: An established patient with acute bronchitis reports to the FP's office for a scheduled nebulizer training session. An advanced registered nurse practitioner (ARNP) provides the patient with training on how to use the device under direct physician supervision. Can I report an E/M and a procedure code? North Dakota Subscriber Answer: In this instance, you cannot code a separate E/M. Since the patient was scheduled for nebulizer training, and that is the only service the ARNP provides, that is the only service you can code. Report 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device) for the encounter. Also, append 466.0 (Acute bronchitis) to 94664. Exception: If the ARNP provides service outside of the nebulizer education during the encounter, you might be able to report a separate E/M. For example, an established patient reports to the FP for nebulizer training. The ARNP provides the patient with guidance on using the device. The patient then tells the ARNP that he has been having serious headaches and dizzy spells lately. The ARNP checks out these symptoms for the patient by taking a problem-focused history and doing a problem-focused exam and provides guidance on treatment. In this case, the ARNP provides the training, then addresses the patient's separate issue (headaches and dizziness) with an E/M service. You can report 94664 and the appropriate-level E/M code appended with modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service).