94060 and 94640

[dballard2004]

I need some further clarification on the correct use of these pulmonolgy codes please. When reporting code 94060 for bronchodilation responsiveness, pre- and post-bronchodilator administration, is it correct that if an inhalation treatment such as a nebulizer treatment is performed and the bronchodilation responsiveness is performed to measure the patient's response to the treatment, you only report the nebulizer treatment? I have a book published by the AMA called Principles of CPT Coding that seems to hint at this, but I want to verify this.

Also, when checking the NCCI edits for these two procedures, it appears that the nebulizer treatment is bundled into code 94060 (the neb code 94640 shows up in column two).

So, which is correct? Does CPT state that in this case you report only the nebulizer, but CMS says you report the bronchodilation responsiveness instead?

I am way confused here!

 

[Lisa Bledsoe]

94060 includes the bronchodilation procedure (not the drug -ie albuteral which is separately reportable). So if the patient has the pre- and post- spiro with neb, code 94060 and the drug. Here is the plain english definition:

Plain English Description™:
Spirometry with bronchodilation responsiveness is a pulmonary function test that is used to help diagnose the cause of shortness of breath and to monitor existing pulmonary disease, such as chronic bronchitis, emphysema, pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), and asthma. The test is first performed without administration of a bronchodilator. A spirometry device consisting of a mouthpiece and tubing connected to a machine that records and displays results is used to perform the test. The patient inhales deeply and then exhales through the mouthpiece. Inhalation and exhalation measurements are first taken with the patient breathing normally. The patient is then instructed to perform rapid, forceful inhalation and exhalation. The spirometer records the volume of air inhaled, exhaled, and the length of time each breath takes. A bronchodilator medication is administered and the test is repeated. The test results are displayed on a graph that the physician reviews and interprets in a written report.

 

[dballard2004]

Lisa,

Thanks so much! One other question....I understand that the neb is inclusive of the 94060 procedure, but what about if you have to administer more than one neb treatment? Could you then report the second neb with -59?

 

[dballard2004]

OK, so just so I am understanding here.....the first neb treatment would be included in code 94060. If a second neb is reported in conjunction with code 94060, would you report the neb with -59? What about if a third neb had to be administered? Would you then report the seond neb with -59, and the third neb with -76 or -59 as well?

 

[Lisa Bledsoe]

OK, so just so I am understanding here.....the first neb treatment would be included in code 94060. If a second neb is reported in conjunction with code 94060, would you report the neb with -59? What about if a third neb had to be administered? Would you then report the seond neb with -59, and the third neb with -76 or -59 as well?

In the scenario where a second neb is administered you would use 94640-59. If a third neb is needed I recommend 94640-76-59. I also think if you do a pre/post 94060, a second neb then another spiro and neb followed by a fourth spiro you would have 94060, 94640-59, 94060-76 (3 nebs and 4 spiros).

 

[dballard2004]

Thanks so much!