Break Down Nebulizer Sessions to Capture Full Reimbursement
Published on Mon Oct 13, 2003
Know when you can bill separately for all services involved You'll report nebulizer services with confidence if you understand how to code each procedure and recognize that payer policies vary.
Although CPT 2003 clarified the nebulizer training codes, pulmonology coders are still asking questions about reporting nebulizer sessions. Pulmonologists often treat patients for wheezing and difficulty breathing due to asthma, lung disorders or upper respiratory infections. These office visits can take a lot of time because they encompass many services, including patient history, examination and medical decision-making, and procedures such as spirometry, bronchodilation and training. (See "Is Your Office Sacrificing Payment for Training and E/Ms?" on page 91 for more on coding for nebulizer training and E/M services.) Report 7 Procedures in Typical Session During a typical nebulizer session, a patient presents for wheezing (786.07). The physician reviews the patient's history and examines him, concentrating on the lungs, upper airways, eyes, ears, nose (particularly the nasal passages) and throat.
The pulmonologist cannot evaluate the airways from the examination alone, so he performs pulse oximetry and uses a spirometer to measure pulmonary function. He administers a bronchodilator to the patient, followed by another pulse oximetry measurement and spirometry. He then compares the before and after readings to assess the bronchodilator's success.
The patient continues to exhibit respiratory symptoms, so the pulmonary physician administers a second bronchodilation followed by spirometry. The pulmonary reading shows that the patient's symptoms are subsiding. The doctor prescribes an inhaler and a spacer for the patient. A nurse demonstrates how to use the inhaler. The pulmonologist and nurse perform seven procedures:
pulse oximetry x 2
spirometry before and after bronchodilation
spirometry
bronchodilation x 2
training
and one service:
an established patient office visit.
Bill for Pulse Oximetry Coverage for pulse oximetry (94760, Noninvasive ear or pulse oximetry for oxygen saturation; single determination) depends on the payer. Medicare announced in January 2000 that it would no longer cover 94760 unless it is the only procedure provided. This means that if you bill any other code on that day, you cannot submit pulse oximetry as well because Medicare has bundled the oximetry codes into every other CPT code. If the pulmonologist performs pulse oximetry and nothing else, you can bill and get paid for this procedure.
Carriers view pulse oximetry as similar to taking a patient's temperature. "Pulse oximetry is no more invasive and arguably less invasive than recording the patient's temperature, another example of a diagnostic service for which we do not make separate payment," according to Medicare's announcement. "If interpretation of pulse oximetry or temperature data is complex, then that interpretation is clearly part of the medical decision-making included in the E/M services." And [...]
