Primary Care Coding Alert

Question: A child with acute asthma requires three same-visit nebulizer treatments to control his asthma. Should I bill 94640 and J7613 multiple times, one time, or one time with a modifier for each additional treatment?


Washington Subscriber


Answer: When your practice administers multiple aerosol treatments on the same date, you should submit 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]) for the first treatment.

Catch: You should append modifier 76 (Repeat procedure by same physician) for subsequent treatments. "For more than one inhalation treatment performed on the same date, append modifier 76" to code 94640, CPT's note following 94640 says.

Therefore, you would code the example of three nebulizer treatments as:
  94640 - first treatment
  94640-76 x 2 - two subsequent treatments. For the inhalation solution, you should report three units of J7613 (Albuterol, inhalation solution, administered through DME, unit dose, 1 mg). Because J7613 represents one "unit dose," you should report it per nebulizer treatment or, in your case, J7613 x 3.

E/M help: If the FP meets the criteria for reporting an E/M code, you should report the appropriate-level E/M code (such as 99214, Office or other outpatient visit for the evaluation and management of an established patient ...) in addition to the pulmonary procedure(s) performed, according to CPT's pulmonary subsection introductory notes.

If the physician performs and documents a significant, separate E/M from the treatment (94640), append the E/M code with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).