Pediatric Coding Alert

When coding for nebulizer treatments, pediatricians may choose either CPT 94640 (nonpressurized inhalation treatment for acute airway obstruction) or 94664 (aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes; initial demonstration and/or evaluation).

If treating a child with a nebulizer for the purpose of improving breathing, use the simple therapy code 94640. A typical 94640 pediatric scenario might involve a 1-year-old who presents with acute wheezing, is treated with an aerosol, improves and is sent home on oral albuterol.

For teaching a child and/or parent how to use a nebulizer during the same encounter in which you provide a nebulizer treatment, use 94664. This common situation arises, for example, when a baby or child first develops wheezing whether from bronchitis, asthma or some other problem. After giving a treatment in the office and determining that it has improved breathing, the pediatrician prescribes home nebulizer treatments. The pediatrician then teaches the child and/or parent how to use the nebulizer.

In another example, a child with recurrent wheezing is diagnosed with asthma and begins outpatient treatment with an albuterol inhaler. Again, 94664 is appropriately reported for demonstrating to the patient proper use of the inhaler.

Note: The descriptor for 94664 does not specifically refer to teaching or training, but does mention demonstration.

If a nurse, rather than a physician, provides the training, report 97535 (self care/home management training [e.g., activities of daily living [ADL] and compensatory training, meal preparation, safety procedures, and instructions in use of adaptive equipment] direct one-on-one contact by provider, each 15 minutes). Do not bill 94664 and 97535 together.

Bill Modifier -59 With 94640 and 94664 Appropriately

You can bill 94640 and 94664 together. You may have to provide treatment and training on the same day, for instance, especially if the child has never used a nebulizer before. The national Correct Coding Initiative bundles these two codes, however, and therefore you must append modifier -59 (distinct procedural service) to 94640.

Both procedures [94664 and 94640] are usually billed with and given during an E/M service that involves an asthma or respiratory problem, explains Joel F. Bradley, MD, FAAP, editor of Coding for Pediatrics and a member of the AAP coding and reimbursement committee. If a patient undergoes a treatment and is also instructed in the use of the nebulizer or the inhaler, 94664 is billed. If further nebulization is required after the teaching nebulizer, code 94640 as well, he recommends.

Bill Units and 97535

For multiple nebulizations, some coders believe its better to report 94640 in units and access the teaching code (97535) instead of 94664. For instance, if a child requires three nebulizations, code 94640 x 2 and 97535 [...]