Pediatric Coding Alert

Question: After receiving a preventive medicine service, the patient has an asthma attack. Should I separately bill the service related to the asthma?


New York Subscriber

Answer: Yes. In this case, you are not doing the same amount of work that you would have if you had just performed a preventive medicine service on the patient. Code the problem-related portion with the appropriate-level office visit code, such as 99214 (Office or other outpatient visit for the evaluation and management of an established patient ...).

Append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99212-99215 to indicate that the office visit is significant and separately identifiable from the preventive medicine service (such as 99391-99394, Periodic comprehensive preventive medicine reevaluation and management of an individual ...).

Don't forget to also code the asthma 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]) and related procedures as appropriate. Separate documentation is optimal to support the 99214-25 work billed, as well as linking the CPT code to a separate and distinct ICD-9 code 493.02 (Extrinsic asthma; with [acute] exacerbation).

Answers to You Be the Coder and Reader Questions reviewed by Richard H. Tuck, MD, FAAP, a national pediatric coding speaker and educator.