Is Your Office Sacrificing Payment for Training and E/Ms?
Published on Mon Oct 13, 2003
Get what you deserve with 94664 and 9921x The next time your practice drops everything to treat an unscheduled patient for wheezing, don't run for the waiting room. Instead, take a deep breath and use these expert tips for billing the training and the office visit.
When treating a wheezing patient (786.07), a pulmonologist can spend hours performing procedures - such as pulse oximetry, spirometry, inhalation treatments and training - and services - including patient history, examination and medical decision-making. If you fail to code for the training and all E/M services, your practice will sacrifice reimbursement. On the other hand, using 99214 or 99215 (Office visit for an established patient) inappropriately could raise red flags and result in charges of fraud. Treatment Does Not Include Training Many pulmonary physicians wonder whether a nebulizer treatment (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]) includes training on the inhaler. Code 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device) is not a treatment, coding experts say. That's because patients can perform the service themselves.
Much of this confusion stems from the earlier definitions of 94664 (Aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes; initial demonstration and/or evaluation) and 94665 (... subsequent) clarified in CPT 2003. The helpful language eliminates the term "initial" and adds "patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device." And, CPT eliminated 94665. These changes clarify that 94664 refers to an inhaler demonstration. "Code 94664 does not include the services described by code 94640," states CPT Assistant, April 2000. Report 94664 for Physician-Supervised Training For the nurse training, you should report 94664. The 2003 National Physician Fee Schedule Relative Value File requires direct physician supervision for 94664. If a member of the office staff demonstrates how to use the nebulizer under direct supervision, use 94664 rather than 99211 (Established patient office visit ...), says Victoria S. Jackson, owner of Omni Management, which provides practice management services for 15 medical offices in the Los Angeles area.
To meet direct-supervision requirements, the physician must be physically present in the same office suite and immediately available to render assistance if necessary. Fight NCCI Training and Evaluation Edits Individual payer policies may cause many pulmonologists to think that 94640 includes training. The National Correct Coding Initiative (NCCI) bundles nebulizer training (94664) into bronchospasm evaluations (94060). So some practices may receive denials for 94664 from payers that follow NCCI edits.
Some third-party payers allow 94664 once per year. But this ruling [...]
