Pediatric Coding Alert

Question: Our provider administered an albuterol treatment to an asthmatic patient that lasted about 50 minutes. Four hours later, the patient returned for a second treatment. This time, the treatment lasted for an hour. Should we code this as 94644 and add on +94645 for the second hour? Or do we report both procedures differently?

North Carolina Subscriber

Answer: The fact that the first treatment lasted under one hour means that you cannot code 94644 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour), as the note in CPT^® that accompanies the code tells coders to use 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device) for services of less than one hour.

So, you would code the first hour with 94640, which means you cannot use the +94645 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; each additional hour (List separately in addition to code for primary procedure)) add-on. Instead, you would append modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional) to 94644 and use it to document the second, full-hour session.