Pediatric Coding Alert

Pediatricians are still confused about how to bill for multiple nebulizer treatments and training sessions. The definition of 94664 (aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes; initial demonstration and/or evaluation) needs clarification. Is this code for teaching a patient how to use a nebulizer? Is it for treatment with a nebulizer? Or is it for both?

The proper code to use for a treatment with a nebulizer is 94640 (nonpressurized inhalation treatment for acute airway obstruction). If a child needs a repeat treatment because the first didnt work, you should use 94960 again with a modifier -76 (repeat procedure by same physician) appended. But what if you need to teach a parent or patient how to use a nebulizer and provide a treatment as well, all on the same day? This is a very common situation for pediatricians, and until the definition of 94664 is clarified, its hard to get a definitive answer for coding this situation.

In general, the recommendation from pediatricians is to use 94664 for a first-time nebulizer treatment that involves teaching, and to use 94640 for subsequent treatments on the same date. Code 94664 includes a treatment, says Charles Schulte, MD, FAAP, the American Academy of Pediatrics (AAP) representative on the American Medical Associations (AMA) CPT advisory committee. So for additional treatments, you would use 94640.

This is an important question for pediatricians because unlike chest physicians, who concentrate on adults, they spend a lot of time teaching patients and parents how to use nebulizers. By adulthood, it may be fairly clear who has asthma and who doesnt. Children, however, may come into the doctors office wheezing, and the pediatrician isnt sure if its asthma or a viral infection or something else.

Richard H. Tuck, MD, FAAP, a member of the AAPs coding and reimbursement committee, sometimes gives a nebulizer to see if the wheezing improves. This, in essence, is a diagnostic test. But Tuck, like many pediatricians, does not bill 94664 because the teaching component is always provided by the nurse and not by the pediatrician. This is a very important point: If only the nurse is teaching patients and parents how to use a nebulizer, you cannot use 94664 instead use CPT 99211 (nurse visit) in this case.

The language for 94664 needs to be cleaned up, says Joel Bradley, MD, FAAP, who practices in Clarksville, Tenn., and is editor of AAPs Coding for Pediatrics. But 94664 is the code you would use for a child when you are providing a nebulizer treatment and teaching how to do it at the same time. If the lungs didnt clear sufficiently after the first treatment, then you would code 94640.

When it comes to 94664, there is no reason why it cant be used for teaching patients how to use inhalers or spacers, comments Bradley. You dont need to restrict the use of the code to nebulizer training.