Primary Care Coding Alert

Question: Our physician performed a pair of inhalation treatments on a patient recently. I reported two units of 94640, and the payer denied the second charge as duplicative. Why did I receive a denial?

New Jersey Subscriber

Answer: The insurer issued a denial because you reported the second treatment improperly.

Try this: Instead of using units -for more than one inhalation treatment performed on the same date, append modifier 76- (Repeat procedure by same physician), according to the parenthetical instruction following 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]).