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.)

Pediatric Coding Alert

Find Out the Newborn Care Codes You Could Be Missing
Time-saver: You can ignore hospital dates when selecting 99435 If your newborn-inpatient encounter sheets are [...]

Capture More for Consult Without Raising Payers' Ire
CPT allows 99241-99245 when RN requests opinion Increased consultation R's means you've got to be [...]

You Be the Coder:
Omit QW on These Test Codes
Question: Do I need to use modifier QW on all lab tests? Louisiana Subscriber [...]

Get Up-to-Speed on a Consultation's 5 R's
Clip and save your 99241-99245 requirement cheat sheet If you still think of three R's [...]

Prove Your RN Did 94664 to Any Doubting Authority
This tool makes documenting MDI instruction a breeze Are insurers denying 94664 or bundling it [...]

Reader Question:
Who Can Teach Nebulizer Use?
Question: Can we bill for nebulizer teaching that a certified medical assistant (CMA) or licensed [...]

Reader Question:
Boost E/M Level When Staff Interpret
Question: We are a very busy pediatric office with four staff pediatricians, three of whom [...]

Reader Question:
Simplify Critical Care Time Recording
Question: I've heard about the importance of documenting critical care time. As a pediatrician, does [...]

Reader Question:
Consider Modifier for MD Suture Removal
Question: Insurers sometimes deny suture removal even though our pediatricians did not repair the laceration. [...]

Reader Question:
Avoid Paybacks for Cloned Documentation
Question: I often use previous electronic medical record (EMR) charts with the same chief complaint [...]

View All