Internal Medicine Coding Alert

Question: Can I report an individual inhalation treatment, such as with a nebulizer, in addition to continuous inhalation treatment?

Texas Subscriber

Answer: No, you may not report codes for these two procedures simultaneously. These procedures are bundled and National Correct Coding Initiative (NCCI) edits do not allow you to override the bundle under any circumstances.

Details: CCI 15.1 makes inhalation treatment codes 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]) and 94642 (Aerosol inhalation of pentamidine for pneumocystis carinii pneumonia treatment or prophylaxis) components of the more extensive procedure 94644 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour). In addition, you may not use any modifier (such as 59, Distinct procedural services) to bypass this CCI edit. Choose the correct code based on time following these guidelines:

• Use 94640 for intermittent inhalation treatment.

• Apply 94644 only to continuous inhalation treatment of one hour or more.

• Use add-on code +94645 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; each additional hour [List separately in addition to code for primary procedure]) for each additional hour.