Pulmonology Coding Alert

Find out if 31 or 60 minutes is the magic number.

When a pulmonologist initiates continuous inhalation treatment for a patient experiencing respiratory distress, the clock begins ticking for this time-based service. If the treatment lasts longer than 60 minutes, the minutes start tallying toward an additional hour, but do you know at what time you can report the add-on code?

Examine the following scenarios to know when to assign an additional hour code.

Know When Time Counts Toward an Additional Hour

Scenario: A provider performs continuous inhalation treatment on a patient experiencing an acute exacerbation of their moderate persistent asthma. The treatment lasts for 75 minutes.

You’ll assign 94644 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour) to report the first 60 minutes of the continuous inhalation treatment. In the scenario listed above, the treatment lasted for 75 minutes, so can you report add-on code +94645 (… each additional hour (List separately in addition to code for primary procedure)) for the treatment’s additional 15 minutes? Most likely, no.

Why? Regardless of whether you’re adhering to a strict interpretation of +94645’s descriptor or following the CPT^® time guidelines, not enough time has elapsed in the additional hour for the code to count toward reimbursement. Your best bet is to check with your individual payer to review their policies on when you can assign +94645 for a treatment that extends past 60 minutes.

Two different interpretations exist for what constitutes an hour when you’re considering reporting +94645.

“CPT^® indicates that codes that stipulate a time requirement would follow a basic rule unless there were code-specific instructions on how to report time. In the case of continuous inhalation treatment, the standard rule would apply. In this case, a unit of time is reached when the midpoint is passed,” says Melanie Witt, RN, MA, independent OB-GYN coding expert based in Guadalupita, New Mexico. So, if the treatment reached 91 minutes, then you could assign 94644 and +94645 if the midpoint time aligns with the payer’s policies.

On the other hand, code +94645’s descriptor states “each additional hour,” which means “you should not report this add-on code until the full 60 minutes is reached (ie, 120 min),” says Carol Pohlig, BSN, RN, CPC, manager of coding and education in the department of medicine at the Hospital of the University of Pennsylvania in Philadelphia. If your payer’s policy follows this interpretation of +94645’s descriptor, then you cannot report the add-on code until the extra hour is completed.

What about 94640? A parenthetical note under 94644 instructs you to use 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device) “for services of less than [one] hour.”

Does this mean you can report 94640 to report the additional 15 minutes of the treatment? No, you cannot assign 94640 in conjunction with 94644 to report the full 75 minutes of treatment. “National Correct Coding Initiative (NCCI) policy prohibits a provider from reporting 94640 and 94644 on the same date by fatally bundling these two services. There is no opportunity to override the edit,” Pohlig says.

Therefore, you’ll report only 94644 for continuous inhalation treatment services that last less than 120 minutes.

Don’t forget the diagnosis: Remember to assign J45.41 (Moderate persistent asthma with (acute) exacerbation), as well as any additional codes that may apply, to report the medical necessity for the treatment.

Report Codes on the First DOS If Midnight Strikes During Treatment

Scenario: A patient presents to an urgent care clinic with an acute exacerbation of their chronic obstructive pulmonary disease (COPD). The physician starts a continuous inhalation treatment at 11:30 p.m. that lasts for 120 minutes.