Internal Medicine Coding Alert

Question: Should we be reporting 94664 when a nurse provides nebulizer education/demonstration/monitoring for a patient? We've never billed it before, but the Medicare fee schedule shows it pays more than the nebulizer code. Can I bill for this? Idaho Subscriber

Answer: Yes, you might be able to report 94664 (Demonstration and/ or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device) if a nurse or other provider shows a patient how to use a nebulizer-type device, such as an inhaler; teaches the patient proper usage including hold and dosing; or observes the patient using the device. The physician or nonphysician provider (NPP) who orders the nebulizer education should indicate the medical necessity for the service, such as incorrect handhold, new prescription, etc.

Beware: The Correct Coding Initiative (CCI) edits bundle 94664 into inhalation treatment code 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). CCI, however, allows you to report a modifier to override the bundle when circumstances make separately reporting the education appropriate. For Medicare and payers that follow the edits, if the education occurs while the patient is receiving the inhalation treatment, do not separately bill the education. If, however, the FP provides the inhalation treatment, and recommends the patient receive education, and the nurse subsequently performs the training at a separate session, you may report 94664 with modifier 59 (Distinct procedural service).

Heads up: When the FP or NPP performs and documents a medically necessary E/M service prior to providing the inhalation treatment or education, some payers may require you to use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the office visit code (99201-99215).