Otolaryngology Coding Alert

Question: A patient required three nebulizer treatments in the office to control her acute asthma. Should I bill 94640 and J7613 multiple times, one time, or one time with a modifier for each additional treatment?

North Carolina Subscriber

Answer: When a patient receives multiple aerosol treatments on the same date, you should use 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]) for the first treatment.

Catch: Subsequent treatments will require modifier 76 (Repeat procedure by same physician), CPT says. Therefore, you would code the example of three nebulizer treatments as:

- 94640 -- first treatment

- 94640-76 x 2 -- two subsequent treatments.

A dose of coding: For the inhalation solution, you should report three units of J7613 (Albuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, 1 mg). Because J7613 represents one "unit dose," you should report per nebulizer treatment or, in your case, J7613 x 3.

What about E/M? If the allergist meets the criteria, you should report the appropriate-level E/M code (such as 99214, Office or other outpatient visit for the evaluation and management of an established patient ...).

If the physician performs and documents a significant, separate E/M from the treatment (94640), 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).

Time is a factor: If the asthma treatment lasted at least an hour, you-d code it with 94644 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour). Report code 94640 for intermittent or one-time treatments.