Primary Care Coding Alert

Question: After receiving a preventive medicine service, an established patient has an asthma attack, which the FP treats with nebulizer treatment. Should I separately bill the E/M service related to the asthma?

New York Subscriber

Answer: Yes. In this case, 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 problem-related portion with the appropriate-level office visit code (99212-99215, depending on encounter specifics).

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 99212-99215 to indicate that the office visit is significant and separately identifiable from the preventive medicine service (such as 99391-99397, 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. In this scenario, you-ll need separate documentation to support the 9921x-25 work, as well as linking the CPT code to a separate and distinct ICD-9 code, 493.02 (Extrinsic asthma; with [acute] exacerbation).