Otolaryngology Coding Alert

Question: May I report a separate procedure (94640) for breathing treatment with bronchospasm evaluation (94060)? Most payers seem to deny this.


Kentucky Subscriber

Answer: The National Correct Coding Initiative (NCCI) bundles spirometry (94060, Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) with 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]), as well as nebulizer training (94664, Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device).

Medicare interprets 94060's definition of pre- and postbronchodilation as a global code, meaning the spirometry includes any treatment and training.

Therefore, carriers that follow NCCI guidelines will not allow you to report nebulizer treatment or training in addition to spirometry on the same day. Some private payers may allow you to bill additional services, however.

Example: A child presents to the ENT's office for wheezing (786.07). The doctor reviews the patient's history, examines the patient and uses a spirometer to take a pulmonary function reading. The physician then administers 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 ENT 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.

Private-payer coding: For the physician's initial patient evaluation and follow-up lung checks, use 99215 and append modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service).

For the spirometry, assign 94060. For the first nebulizer treatment, assign 94640. For the second treatment, assign 94640-76 (Repeat procedure by same physician), according to CPT. For the training, use 94664.

Medicare coding: You can't bill for the inhalation treatment (94640) and the training (94664) in addition to the spirometry (94060) for Medicare or payers that follow Medicare guidelines: NCCI bundles 94640 and 94664 with 94060. You may, however, consider face-to-face treatment and training time when determining the appropriate E/M level.

You can override the edits: NCCI designates a -1- for the spirometry bundles, meaning you may use a modifier to override the edit. For instance, a patient with acute exacerbation returns to his otolaryngologist's office later that day. 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.