Pulmonology Coding Alert

Question: Our office provides inhalation therapies. Which codes specifically apply to which treatments and therapies? How should I code differences between administration of an aerosol inhalant and administration of a metered-dose inhalant?

New Jersey Subscriber

Answer: Typically, correct coding for therapeutic aerosol inhalations would be 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]). Code 94640 also allows you to bill for the drug used in the treatment, such as albuterol, J7613.

If the bronchodilator treatment is repeated, append modifier 76 (Repeat procedure by same physician) to 94640 on the subsequent line items for 94640. For continuous inhalation treatment of 1 hour or more, you can report codes 94644 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour) and 94645 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; each additional hour [List separately in addition to code for primary procedure]). You should use code 94640 for either form of administration (metered or aerosol) that is for care of the patient with an acute airway obstruction such as asthma or croup. The physician may order either one to treat an acute bronchospasm, but because it’s for the same purpose, use the same procedure code.

To train the patient on the use of a new type of equipment such as a metered-dose inhaler, a healthcare professional administers the medication to the patient and gives instructions. The patient is observed and evaluated to ensure appropriate use. Code 94664 is used for the demonstration/evaluation, It is important to check with your carrier regarding the proper reporting of 94664.

Use E/M codes (99201-99215 for outpatients, 99221-99239 for inpatients) with the nebulizer codes (94640 and 94664-94665, the latter two depending on the intent of the therapy -- treatment of acute obstruction or demonstration, for example). If a separately identifiable E/M service was performed on the same day, add modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

When billing nebulizer treatments, be certain the patient’s medical record clearly illustrates medical necessity. This includes a physician’s orders, plans of treatment, the patient’s response to treatment, and ongoing assessments.