Pediatric Coding Alert

Question: We have never billed for the nurse’s services showing a patient how to use a nebulizer because it doesn’t take that long. Our pediatrician just came back from a coding seminar and said we should be reporting this. Can you advise?

Answer: Your pediatrician is correct. You should not write off training episodes when you teach a patient how to use a nebulizer or metered dose inhaler (MDI). Taking that simple step with your established patients can garner extra pay each time you report 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device). Currently, the national adjusted Medicare fee for non-facility service is $17.19, so check your other payers’ fee schedules. You can repeat education at future visits as necessary to ensure optimal use of an aerosol machine or metered dose inhaler.

Most insurers also allow you to report 94664 when training patients on how to use the Advair Diskus. This training should be separately documented by the health professional providing the training, and counter-signed by the physician as an incident-to service.

Example: A pediatrician starts a patient with asthma (493.00, Extrinsic asthma; unspecified) on Advair. A nurse then teaches the patient how to use the diskus. You should report 99201-99215 for the office visit and 94664 without a modifier, according to CPT® guidelines. 

Beware: Before dropping modifier 25 from 99201-99215 with 94664, check with your major insurers. Some payers may require modifier 25 appended to the E/M when performed with 94664 or any “pulmonary service.” 

During the teaching, the patient may receive a medication dose. In this case, you should not separately report the 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]).

If, however, the patient was treated with an aerosol for acute wheezing and separate instruction follows when the pediatrician decides to send the patient home with an aerosol machine, bill the following: 94640 and 94664-59 (Distinct procedural service) for the training. Otherwise, the payers will assume that the training was included in the aerosol that was given.

Reason: The administration was performed as part of the demonstration/evaluation, and the service’s intent was patient education.