Pulmonology Coding Alert

Question: Can you give me an example of when modifier 76 should be used in pulmonology practice?Wisconsin SubscriberAnswer: An asthmatic patient presents to the office with a moderate exacerbation of symptoms including audible wheezing, chest tightness and shortness of breath. The physician evaluates the patient and administers a bronchodilator treatment via nebulizer. Afterwards, the physician re-evaluates the patient, who continues to have audible wheezing and chest tightness with some improvement. The physician administers another nebulizer treatment in an effort to minimize the acute flare. In addition to the E/M, the physician reports 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device]) and 94640-76 (Repeat procedure or service by same physician). (See Article 2 for a similar example.)