Pulmonology Coding Alert

If demo is inevitable, you may have to look beyond a diagnostic procedure.

Does your physician administer airway inhalation therapy treatment several times a day at short intervals (e.g., 10 minutes)? If you don't know the distinction between 94640 and other inhalation treatment codes, you may find your claim in limbo land.

Here's an opportunity to test your skill with some tricky 94640 situations. Compare your answers with the solutions provided on page 77.

Scenario 1: When an established patient with emphysema presents complaining of shortness of breath, the physician administers inhalation treatment. During the therapy, the physician trains the patient on using the nebulizer at home, and provides an expanded problem-focused examination and medical decision-making of low complexity. How should you report it?

Scenario 2: Say the physician from the first scenario -- after performing an inhalation treatment -- determines that the patient's plan of care should include inhalation therapy. The patient is new to this therapy and does not know the administration techniques involved in the procedure, so the physician provides a demo. This warrants both 94664 and 94640 on the same day, but does Medicare allow pairing?

Scenario 3: The patient receives nebulizer treatment followed by a broncholidation responsiveness test to measure the patient's response to the treatment. Should you report only the nebulizer treatment?