Allergy Coding Alert
Reader Question: Bronchospasm Evaluation and Bronchodilator
Question: We have been billing for the bronchospasm evaluation and the bronchodilator at the same time. Our carriers are not paying for the bronchodilator. Why?
Pennsylvania Subscriber
Pennsylvania Subscriber
Answer: Probably because the two services are bundled in the national Correct Coding Initiative (CCI). Bronchodilation is a treatment that aims to increase the caliber of a bronchus through the use of inhaled vapors or aerosols to mobilize sputum, dilate the bronchi and improve sputum production when sputum is collected for evaluation. The initial evaluation and treatment is reported using 94664 (aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes; initial demonstration and/or evaluation).
If the physician also performs a bronchospasm evaluation, however, the bronchodilation may not be billed separately. The evaluation, which is coded 94060 (bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]), measures functions of the lungs, such as the amount of air in the lungs, the rate of expiration and the amount of air respired by the patient, and involves bronchodilation.
As a result, 94664 is bundled with 94060 in version 7.3 of the CCI and should not be billed separately if your carrier follows the CCI. The edit has a 1 indicator, which means it may be bypassed if a modifier such as -59 (distinct procedural service) is used to indicate that the two services were distinct (for example, if they were performed at different times during the same day).
If your carrier pays for 94664 when billed in conjunction with 94060, try to obtain its policy in writing to avoid potential audit problems.
- Published on 2001-12-01
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