Primary Care Coding Alert

Example #1: A 13-year-old boy comes into the office for an unscheduled visit after soccer practice. He is coughing, wheezing and having difficulty breathing. After conducting a pulmonary function test and measuring the boys oxygen saturation, the physician provides nebulizer therapy. After 30 minutes, the patients symptoms have been only partially relieved and the treatment is repeated. The second inhalation alleviated the patients distress and, after observation, a metered-dose inhaler is prescribed. The nurse explains how the inhaler works and conducts a demonstration.

Coding:

Office visit E/M code (e.g., 99213, office or other outpatient visit, established patient) to reflect the level of service documented; with modifier -25 (significant and separately identifiable service)

Pulmonary function test 94010, spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation.

Oximetry 94760, noninvasive ear or pulse oximetry for oxygen saturation; single determination (note: Medicare and some payers may bundle oximetry with E/M code).

Nebulizer treatment 94640, nonpressurized inhalation treatment for acute airway obstruction.

Repeat treatment 94640-76, repeat procedure by same physician.

Demonstration 94664-59, aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes; initial demonstration and/or evaluation,-distinct procedural service.

Medication J7618 x 3 (two treatments, one demonstration), albuterol, all formulations including separated isomers, inhalation solution administered through DME, concentrated form, per 1 mg.

Example #2: A 75-year-old woman schedules an appointment because of tightness in her chest, accompanied by fever, difficulty catching her breath and cough. Symptoms have lasted four days and have worsened during that time. Suspecting pneumonia, the family physician uses nebulizer therapy to assist the patient in producing sputum for a sputum culture. The patient also indicates that the inhaler has eased her breathing. The physician prescribes antibiotics and an inhaler to relieve symptoms. Two days later, the patient calls the office saying the inhaler has not been working properly. An appointment is scheduled, and the nurse reviews use of the inhaler with the patient.

Coding:

First date of service E/M code (e.g., CPT 99214 , office or other outpatient visit, established patient) to reflect the level of service documented, with modifier -25 (significant and separately identifiable service).
Nebulizer therapy, first date 94664, aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes; initial demonstration and/or evaluation.
Demonstration, second date 94665, subsequent.