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Pediatric Coding Alert

READER QUESTION:

Use Modifier to Report Inhalations

Published on Mon Jan 01, 2007

Question: When I bill two units of 94640, insurers deny the second charge as duplicative. Should I appeal these denials?


New Jersey Subscriber


Answer: Actually, you are incorrectly billing the second inhalation treatment. Instead of using units "for more than one inhalation treatment performed on the same date, append modifier 76" (Repeat procedure by same physician), according to the parenthetical instruction following 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]).
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