Pulmonology Coding Alert

Question: We are getting different answers from Medicare and other insurance companies regarding billing nebulizations (94640) with an exercise study (94620) and with pre-post spirometry (94060). Do you know if we can bill nebulization with either of these CPT codes? Tennessee Subscriber Answer: The key to understanding how to use 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]), 94620 (Pulmonary stress testing; simple [e.g., prolonged exercise test for bronchospasm with pre- and post-spirometry]) and 94060 (Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]) lies in the Correct Coding Initiative (CCI) edits. A bronchospasm evaluation involves the use of spirometry (94010) and bronchodilation (94640). Spirometry is performed before and after the doctor administers a bronchodilator to dilate the airways. Stress testing by definition includes the exercise test for bronchospasm with spirometry.

Taking a closer look at the official CCI edits, you will see that several codes are bundled under 94060: 94010 Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation 94375 Respiratory flow volume loop 94200 Maximum breathing capacity, maximal voluntary ventilation Inhalation treatment and demonstration (94640, 94664) 94770 Carbon dioxide, expired gas determination by infrared analyzer 94640. Note the numerous codes bundled into 94620: Cardiovascular stress tests (93015-93018) Rhythm ECG (93041-93042) 94010 94060 94200 94250 Expired gas collection, quantitative, single procedure (separate procedure) Oxygen uptake tests (94680-94690) Pulse oximetry (94760-94761) 94770 Carbon dioxide, expired gas determination by infrared analyzer. You can see that 94640 will not be reimbursed separately from 94060, and 94060 will not be reimbursed separately from 94620. However, 94640 is not bundled under 94620. Therefore, you can bill separately for inhalation treatment given on the same day as pulmonary stress testing as long as 94640 and 94620 were the only services provided on that day. Otherwise, it would be inappropriate to unbundle the 94640 and report it as a "separate" procedure when it was performed as a part of the 94060. The only time you can report these services separately is with the use of modifier -59 (Distinct procedural service).