Part B Insider (Multispecialty) Coding Alert

Question: If our pulmonologist performs spirometry to assess a patient and then decides to perform inhalation treatment for the patient, can I report both the procedures together? Also, if our clinician performs multiple inhalation treatments to the same patient in the same day or session, can these be reported with multiple codes or should it just be reported with one CPT® code?

Answer: If your pulmonologist performs a spirometry prior to performing inhalation therapy, you can report both the procedures for the same session. So, in this case you will be reporting both 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) for the spirometry procedure and 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 inhalation therapy.

If multiple inhalation treatments were provided to the same patient in the same day or session, you can report these separately. In such a case, you will be reporting 94640 for the first inhalation treatment and the subsequent inhalation treatments will be reported with 94640 with the modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) appended to it. The usage of the modifier will let the payer know that multiple inhalation treatments were provided to the patient within the same session and will avoid denial. Should the inhalation therapy be provided continuously for at least 1 hour, consider 94644 instead. (94645, each additional hour, would likely not take place in the office setting).

You should also note that there is no Correct Coding Initiative (CCI) edits between 94010 and 94640. So, you do not have to use any modifiers when reporting these two procedural codes together.