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Answer: It is often necessary to administer nebulizer or MDI treatments in an allergist's office. Nebulizers are popular among asthmatics because they break a medication solution into an aerosol mist that can be inhaled. A metered-dose inhaler (MDI) is lighter and does not need a power source. MDIs use a pressurized canister to deliver the medication. This is usually the point of contention for most coders. The revised 2003 CPT codes help clarify this issue:
94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device)
94664 Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device, with a cross-reference (94664 can be reported one time only per day of service)
94665 has been deleted in the 2003 edition.
Suppose a 10-year-old girl has an acute asthma attack after participating in a track meet. She is rushed to her allergist's office, and a nebulizer treatment is given immediately. In this case, you would use 94640. If the first treatment does not produce the desired results, a subsequent nebulizer treatment would be billed using 94640 with modifier -76 (Repeat procedure by same physician) appended.
In most cases, this encounter will include E/M services, such as taking the patient's history, performing an examination, and participating in medical decision-making. When this occurs, you can report the E/M service coded to the appropriate level of service. Be sure to append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M service (e.g., 9921x-25). In addition, bill for the supply of the drug using the HCPCS manual.
The above scenario would include three CPT codes, along with the diagnosis and drug supply codes:
493.00 Extrinsic asthma; without mention of status asthmaticus
94640
94640-76
9921x-25
J7618 Albuterol, all formulations including separated isomers, inhalation solution administered through DME, concentrated form, per 1 mg (Albuterol) or per 0.5 mg (Levalbuterol).
Code 94664 is used only to report demonstration and evaluation services. These codes are not used with patients having an acute attack. For instance, a 15-year-old girl, recently diagnosed with asthma, must be instructed on how to use the MDI and put on the treatment. It is appropriate to use 94664 along with the diagnosis code. Drug and supply codes may not be reported with these services, although an E/M code can be used with modifier -25 appended.
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