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Pediatric Coding Alert

Reader Question:

Who Can Teach Nebulizer Use?

Published on Fri Sep 28, 2007

Question: Can we bill for nebulizer teaching that a certified medical assistant (CMA) or licensed practical nurse (LPN) performs, or does a physician or other provider have to do the teaching?

Kentucky Subscriber

Answer: A CMA or LPN may perform the instruction and evaluation described in 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device).

Catch: When a nurse or medical assistant shows a patient how to use a nebulizer and/or evaluates a patient's use of the device, you should bill 94664 incident-to the on-duty pediatrician. Therefore, make sure you meet the insurer's incident-to guidelines, which may follow Medicare's that require the pediatrician:

provide direct supervision (be present in the office suite) throughout the procedure
establish the treatment plan of care
countersign the CMA's or LPN's separate note documenting the instruction. (For a useful tool that supports 94664, see "Prove Your RN Did 94664" at left.)

Other Articles in this issue of

Pediatric Coding Alert

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Omit QW on These Test Codes
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Get Up-to-Speed on a Consultation's 5 R's
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Prove Your RN Did 94664 to Any Doubting Authority
This tool makes documenting MDI instruction a breeze Are insurers denying 94664 or bundling it [...]

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Question: I've heard about the importance of documenting critical care time. As a pediatrician, does [...]

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Consider Modifier for MD Suture Removal
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