Pulmonology Coding Alert

A nebulizer, which allows a patient to receive asthma medicine in the mist form, often is prescribed for patients with severe asthma who have difficulty using a metered-dose inhaler. Several codes might apply (94640, 94664 and 94665). Choosing the correct one is easier when you understand which code refers to therapy and which is used to report providing instructions about using the equipment.

Code 94640 Can Be Reported Twice

Walter J. ODonohue, MD, a representative to the American Medical Association (AMA) CPT Advisory committee for the American College of Chest Physicians, advises reporting code 94640 (nonpressurized inhalation treatment for acute airway obstruction) when an inhalation treatment is administered for an acute airway obstruction such as asthma or croup. Code 94640 may be billed twice if the procedure is repeated on the same day. Suppose a 52-year-old patient presents with diffuse wheezing and bronchospasm, ODonohue says. You would report code 94640 twice if you administer a nebulized bronchodilator using a metered-dose inhaler and chamber, and the treatment is repeated after 30 minutes with good response. You should append modifier -76 (repeat procedure by the same physician) to the repeated code (94640-76).

Code 94664 Is for Demonstration or Diagnosis

Code 94664 (aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes; initial demonstration and/or evaluation) is appropriate to report when a patients sputum is analyzed for bacteria, or in other situations that include diagnoses or instruction on using the nevulizer.

ODonohue stresses that code 94664 does not include the services described in 94640. As an appropriate example of using 94664, ODonohue mentions a 70-year-old patient diagnosed with chronic bronchitis and thick secretions. The patient is instructed on how to use a metered-dose inhaler with a chamber and put on this treatment.

Report Code 94665 for Repeat Demonstrations

If the 70-year-old patient returns and is newly diagnosed with asthma and thick secretions, he may be placed on a metered-dose inhaler with a chamber. This would follow a repetition of the instruction for using the device, after the patient is observed and evaluated for appropriate use and response. The service is described by code 94665 (aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes; subsequent).

When the services are performed at a patient encounter subsequent to the date of the 94664 service, 94665 applies, ODonohue says. And he says that deciding whether to report code 94660 or 94664 depends on whether the nebulizer treatments performed were for demonstration or instructional.

CCI Version 6.1 Delayed Due to errors in comprehensive and component code-pair edits, the Health Care Financing Administration (HCFA) delayed the implementation of the national Correct Coding Initiative (CCI) version 6.1 until May 1. The initial release of version 6.1 contained 3,727 code pairs mistakenly identified with a correct coding modifier of 0 (which signifies that no modifier may be used to unbundle these services) instead of a 1 (which signifies that an appropriate modifier may break the component code from its bundled status). Version 6.1 also listed 55 code pairs with a 1 modifier instead of a 0. This error potentially could have caused providers to have unbundled these component codes illegally, which could be a red flag for an audit. HCFA expects that all errors will be corrected by May 1. The National Technical Information Service (NTIS) publishes the CCI edits, along with several other commercial resellers who purchase the raw data from NTIS. According to NTIS, all of its customers, including subscribers and resellers such as Medical Management Institute, Medicode and St. Anthonys, received an errata sheet soon after HCFA made NTIS aware of the errors. As soon as the errors are corrected, users of any CCI edit products should make sure they have a corrected copy of version 6.1, either in the form of an errata sheet or an updated book. Practices should talk to their insurance carriers to ensure they are using accurate CCI information until version 6.2 is released and implemented on July 1, 2000.