Reader Question: Report Office Visit Separately

Question: Can we charge 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device) with an office visit?

North Carolina Subscriber

Answer: Yes, you can report 94664 separately from an E/M code. The 2002 National Physician Fee Schedule lists 94664 with status code "A." This means that carriers should pay separately for the code in addition to another service, including an office visit. The question remains as to whether the physician meets the criteria needed to use modifier -25 with the office visit.

You should use modifier -25 when the physician performs a "Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service." In other words, if the physician performs parts of an E/M visit other than simply evaluating the patient's understanding and use of the nebulizer, such as evaluating the patient's asthma, this would qualify as a separate service.

For reimbursement purposes, you should provide separate diagnosis codes for the E/M and nebulizer treatment when available. A separate diagnosis code will help clarify why the physician needed to perform a separate E/M service. But if the only diagnosis code that seems to accurately explain the E/M service is also the diagnosis code that justifies the procedure code, stick to that diagnosis. In other words, don't go fishing for a second diagnosis code just to get the claim paid.

Answers to You Be the Coder and Reader Questions were provided by Carol Pohlig, BSN, RN, CPC, at the University of Pennsylvania department of medicine in Philadelphia and reviewed by Brett Stanaland, MD, allergist/immunologist at Naples Community Hospital in Naples, Fla., and assistant clinical professor of medicine at the University of South Florida.