Pulmonology Coding Alert

Hint: Don’t forget to report any prior E/M services separately.

When your pulmonologist provides inhalation treatment along with training, you’ll need to focus on distinguishing whether these services were separate or not to arrive at the appropriate CPT^® codes you need to report for the session.

Example: A patient visits your pulmonologist’s office with acute obstruction of the airway. Your pulmonologist prescribes a bronchodilator and performs inhalation therapy using an aerosol generator. During the therapy, your physician also trains the patient about the use of the aerosol generator.

In the above scenario, you report 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]).

However, you should not separately report 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device). This is because, in such instances, the training is inherent in the treatment provided and does not warrant separate reporting. “If the physician orders a bronchodilator treatment and instructs the patient on the use of the device delivering the bronchodilator, the code 94640 should be used,” says Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine, Atlanta.

Know When to Report 94644 as a Separate Service

Example: Your pulmonologist provides treatment to and instructs a patient with acute airway obstructions about using a metered-dose inhaler (MDI). Then, your pulmonologist decides to revise the treatment plan and includes treatment using a dry powder inhaler (DPI) and also instructs the patient on the use of the DPI.

The above situation warrants the reporting of 94644 for the demonstration that your pulmonologist provided in addition to 94640 for the inhalation treatment. Don’t forget to append the modifier 59 (Distinct procedural service), which indicates to the payer that the patient received two separate services on the same day.

To ensure that your claim is paid, provide the necessary documentation, which indicates the specific requirement to perform these two services separately.

Report Multiple Sessions of Inhalation With Suitable Modifiers

You’ll need to be aware that the code 94640 covers a single, short-term inhalation treatment. Therefore, if a patient with established asthma or any other respiratory condition, who has previously received inhalation treatment and training, requires that the treatment be performed again on the same day you have to report  the code 94640 with the modifier 76 (Repeat procedure or service by the same physician or other health care professional). Some insurance companies may not recognize modifier 76 and thus it is important that you check with your payer before filing your claim using this modifier. So, you will need to file your claims for multiple sessions of inhalation therapy with 94640, 94640-76.

Distinguish Between Short and Continuous Inhalation Therapy

Instead of multiple sessions of short-term inhalation therapy, if your pulmonologist performs continuous inhalation for 60 minutes or more, you’ll have to report this service with 94644 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour) for the first hour of treatment. For any additional time beyond the first hour of continuous therapy, you’ll need to report the services provided by your pulmonologist with +94645 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; each additional hour [List separately in addition to code for primary procedure]).

Reminder: The Correct Coding Initiative (CCI) edits indicate that code 94640 is a column 2 code for 94644. Therefore, these codes cannot be billed together under any circumstances. Code 94640 is bundled into code 94644 as this is a more extensive procedure.

Watch for Instances to Report any Same Session E/M Service Performed

If prior to providing inhalation treatment, your pulmonologist thoroughly assessed the patient by performing an E/M service, you’ll need to capture these services performed with the appropriate E/M code for the visit. In order to ensure reimbursement for the E/M claims, you’ll need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code that you are reporting to enable the payer to know that this service was separate from the inhalation treatment that ensued.

Example:Your pulmonologist reviews a patient whose symptoms of wheezing have not subsided with previously prescribed medications. He also complains of developing dyspnea on the slightest exertion. Your pulmonologist performs a detailed evaluation of the patient’s previous history and assessment of the patient’s symptoms. Based on the observations and a detailed examination, your pulmonologist perform an inhalation therapy using a nebulizer for the acute exacerbation of the patient’s chronic asthmatic condition.

What to report: Since the patient is an established patient, you will have to report the E/M services provided with 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components…typically, 25 minutes are spent face-to-face with the patient and/or family) with the modifier 25 appended and the inhalation therapy with 94640.

Don’t forget: You’ll need to provide adequate documentation that supports your claims for the E/M code or else your claim might get denied.