Pulmonology Coding Alert

Look out for some much-awaited revisions to pulmonology codes for 2003 that will greatly affect your coding for the next year and bring relief to many of your questions regarding pulmonology procedures.

The newest changes to the CPT nomenclature will go into effect on Jan. 1, 2003. There are new codes and revisions that will affect your billing for nebulizer treatment, allergy testing, and critical care services. Therefore, you need to be clear on the new changes in order to optimize your reimbursement for the upcoming year. Clarification of Nebulizer Treatment Codes Have you often found yourself wondering why the clinical aspects of nebulizer treatments are not grouped together under one code, while leaving the evaluation and demonstration techniques for a separate code? Beginning in 2003, CPT has revised several inhalation treatment codes to clarify this issue: 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) with a cross-reference (For more than one inhalation treatment performed on the same date, append modifier -76) 94664 Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered-dose inhaler or IPPB device with two cross-references (94664 can be reported one time only per day of service) and (94665 has been deleted). There has been much confusion in the past regarding coding for the use of nebulizers as opposed to multidose inhalers (MDIs). Coders questioned whether MDIs were considered nonpressurized and included under 94640. The current changes were made to clarify the use of aerosols and bronchodilators and also to grow with current medical practice.

The intermittent positive pressure breathing treatment codes (94650-94652) have been deleted and are included in 94640. Carol Pohlig, BSN, RN, CPC, reimbursement analyst for the department of medicine at the University of Pennsylvania in Philadelphia, states that these decisions make logistical sense because now CPT separates the diagnostic and therapeutic services (94640) from the patient-education services (94664). Prior to the 2003 change, the diagnostic sputum induction was lost in 94664. For instance, a 58-year-old man presents in the office with increased difficulty breathing. Since he is not having an acute problem such as an asthma attack, the pulmonologist needs to determine what is causing the condition. A nebulizer treatment is given to induce sputum, which will then be evaluated. The sputum is tested for bacteria, viscosity, color or smell. In this case, the nebulizer is used for diagnostic purposes only. In the past you coded 94664. Beginning in 2003, however, you will need to code 94640 because the diagnostic aspect will be included with the treatment for acute problems. In another scenario, Anthony Marinelli, MD, [...]