Primary Care Coding Alert

Question: During a recent encounter, the physician provided a preventive medicine service to a patient. Before the treatment ended, the patient had an asthma attack. Can I report the asthma-related service separately?

New York Subscriber

Answer: You can in this case, since you are not doing the same amount of work that you would have if you had just performed a preventive medicine service on the patient. Code the asthma-related portion with the appropriate-level office visit code, such as 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history, detailed exam, and medical decision-making of moderate complexity).

Be sure to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the office visit code to indicate that it is significant and separately identifiable from the preventive medicine service (such as 99391-99394, Periodic comprehensive preventive medicine reevaluation and management of an individual ...).

Don't forget to also code the asthma 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]) and related procedures as appropriate.
 Separate documentation is optimal to support the work billed, as well as linking the CPT code to a separate and distinct ICD-9 code, such as 493.02 (Extrinsic asthma; with [acute] exacerbation).