Primary Care Coding Alert

Question: What's the best code to submit when one of our providers offers asthma education to an asthmatic patient?

Tennessee Subscriber

Answer:You should typically report asthma education with 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device).

Payers generally allow 94664 once per year, but the fee might go toward a patient's deductible. Remember to advise patients about this, so they don't see the charge toward their deductible on the EOB later and call your office with complaints.

Modify it: Providers sometimes offer the education and administer an inhalation 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]) during the same patient encounter. If so, append modifier 59 (Distinct procedural service) to 94664 in order to be paid. Otherwise, payers will typically bundle 94664 into 94640, if they follow National Correct Coding Initiative (NCCI) edits.