Otolaryngology Coding Alert

Question: Does 94060 include the breathing treatment, or should I report a separate code, such as 94640, for the breathing treatment?

Tennessee Subscriber

Answer: Code 94060 (Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]) is for the spirometry, the evaluation/measuring of the respiratory gases, not the patient evaluation. Use an E/M code (99211-99215, Established patient office visit) for the patient's evaluation before and after the nebulizer's administration. Append the E/M code with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to indicate a separately identifiable E/M service from the spirometry.

The national Correct Coding Initiative bundles spirometry (94060) with an inhalation treatment (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 training (94664, Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device). (CPT 2003 deleted 94665 [ subsequent] for subsequent training sessions.)

For carriers that follow CCI, you cannot report a treatment or training in addition to spirometry on the same day. Medicare interprets 94060's definition of pre- and postbronchodilation as a global code, meaning the spirometry includes any treatment and training. Private payers may allow you to bill additional services.

For instance, a child presents to an otolaryngologist's office for wheezing (786.07). The otolaryngologist reviews the patient's history, examines the patient and uses a spirometer to take a pulmonary function reading. The physician then gives a nebulizer treatment. He checks the patient's lungs for continued respiratory symptoms and decides to administer a second inhalation treatment. Subsequent lung evaluation shows that the patient's symptoms have improved. The otolaryngologist prescribes nebulizer treatments for the child and teaches the mother and child how to use the device. The total documented evaluation time is 40 minutes.

For the otolaryngologist's initial patient evaluation and follow-up lung checks, use 99215 appended with modifier -25. For the spirometry, assign 94060. The physician must use a spirometer that displays results graphically to bill 94060. If the doctor uses a handheld peak-flow meter to take the reading, the service is not separately billable. For the first nebulizer treatment, report 94640. For the second treatment, assign 94640-76 (Repeat procedure by same physician), according to CPT. For the training, use 94664.

Although this represents correct CPT coding, you can't bill for the inhalation treatment (94640) and the training (94664) in addition to the spirometry (94060), according to Medicare and CCI. CCI bundles 94640 and 94664 with 94060. You may, however, include face-to-face treatment and training time in the E/M.

CCI designates a "1" for the spirometry bundles, meaning a modifier is allowed to override the edit. For instance, a patient with acute exacerbation returns to his otolaryngologist's office. The physician administers a treatment only. You should bill 94640-59 (Distinct procedural service) to indicate a separate session from the spirometry that was performed earlier.