Pulmonology Coding Alert

A nebulizer, which allows a patient to receive asthma medicine in the mist form, often is prescribed for patients with severe asthma who have difficulty using a metered-dose inhaler. Several codes might apply (94640, 94664 and 94665). Choosing the correct one is easier when you understand which code refers to therapy and which is used to report providing instructions about using the equipment.

Code 94640 Can Be Reported Twice

Walter J. ODonohue, MD, a representative to the American Medical Association (AMA) CPT Advisory committee for the American College of Chest Physicians, advises reporting code 94640 (nonpressurized inhalation treatment for acute airway obstruction) when an inhalation treatment is administered for an acute airway obstruction such as asthma or croup. Code 94640 may be billed twice if the procedure is repeated on the same day. Suppose a 52-year-old patient presents with diffuse wheezing and bronchospasm, ODonohue says. You would report code 94640 twice if you administer a nebulized bronchodilator using a metered-dose inhaler and chamber, and the treatment is repeated after 30 minutes with good response. You should append modifier -76 (repeat procedure by the same physician) to the repeated code (94640-76).

Code 94664 Is for Demonstration or Diagnosis

Code 94664 (aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes; initial demonstration and/or evaluation) is appropriate to report when a patients sputum is analyzed for bacteria, or in other situations that include diagnoses or instruction on using the nevulizer.

ODonohue stresses that code 94664 does not include the services described in 94640. As an appropriate example of using 94664, ODonohue mentions a 70-year-old patient diagnosed with chronic bronchitis and thick secretions. The patient is instructed on how to use a metered-dose inhaler with a chamber and put on this treatment.

Report Code 94665 for Repeat Demonstrations

If the 70-year-old patient returns and is newly diagnosed with asthma and thick secretions, he may be placed on a metered-dose inhaler with a chamber. This would follow a repetition of the instruction for using the device, after the patient is observed and evaluated for appropriate use and response. The service is described by code 94665 (aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes; subsequent).

When the services are performed at a patient encounter subsequent to the date of the 94664 service, 94665 applies, ODonohue says. And he says that deciding whether to report code 94660 or 94664 depends on whether the nebulizer treatments performed were for demonstration or instructional.

CCI Version 6.1 Delayed

Due to errors in comprehensive and component code-pair edits, the Health Care Financing Administration (HCFA) delayed the implementation of the national Correct Coding Initiative (CCI) version 6.1 [...]