Pulmonology Coding Alert

Question: An established patient with acute bronchitis reports to the pulmonologist's office for a scheduled nebulizer training session. A nurse provides the patient with training on how to use the device under physician supervision. Can I report an E/M and a procedure code?North Dakota SubscriberAnswer: 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 nurse 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 for the patient's diagnosis.Exception: If the nurse provides service outside of the nebulizer education during the encounter, you might be able to report a separate E/M.For example, the patient reports to the pulmonologist for nebulizer training. The nurse provides the patient with guidance on using the device. The patient then tells the nurse that he has been having serious headaches and dizzy spells lately. The nurse checks out these symptoms for the patient and provides guidance on treatment (a level-one E/M service). In this case, the nurse provides the training, then addresses the patient's separate issue (headaches and dizziness) with an E/M service.You would report the following:• 94664 for the training• 466.0 appended to 94664 for the patient's acute bronchitis• 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) for the E/M• 784.0 (Headache) linked to 99211 for the patient's headaches• 780.4 (Dizziness and giddiness) linked to 99211 for the patient's dizzy spells• modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) linked to 99211 to show that the E/M and training were separate services.