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94640 In-Office Nebulizer Treatments

T

Tbeechler

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10
Location
Maryville
We have been seeing denials from insurance companies when we see a patient and bill for an office visit with a nebulizer treatment. They are denying the office visit and paying only for the nebulizer treatment. Is anyone else having this issue? What are you doing/suggestions on what to do to get around it? Thanks!
 
additional

What is the level of office visit you are coding for? Is the diagnosis consistent with the medical necessity of a nebulizer tx? Are you using any modifiers?
 
We are using a 99213. Pt presented with wheezing, coughing, fever, SOB. The pulse ox warranted, along with presenting problems, the nebulizer treatment. I didn't use any modifiers as I wasn't sure which one would really apply. Mod 25 wouldn't work because of the same dx code being used.
 
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