Pulmonology Coding Alert

Question: A 30-year-old woman presents to an outpatient office for a history of asthma and rapidly worsening shortness of breath and wheezing. The pulmonologist obtained a history, and examination confirms severe airflow obstruction. She also reduced peak expiratory flow, provided supplemental oxygen and 2 L/min via nasal cannula. Then the physician ordered continuous nebulizer treatment, albuterol 10 mg/h, administered for three hours in the office. After symptoms and PEFR improve, the physician reassessed the patient, and dismissed her home with modification of prescriptions for ongoing care. How should I report this?

Kansas Subscriber

Answer: For this service, you would code the continuous nebulizer treatment as:

• 94644 -- Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (once)
• 94645 -- Continuous inhalation treatment with aerosol medication for acute airway obstruction; each additional hour [List separately in addition to code for primary procedure] (for 2 additional h)
• the medication code J7613 (Albuterol, inhalation solution, fda-approved final product, noncompounded, administered through dme, unit dose, 1 mg) for the albuterol (per milligram, for the number of milligrams delivered)
• the appropriate evaluation and management code for the clinical visit (e.g., 99212--"99215).

Tip: Formerly, modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) would have been appended to the E/M code to indicate the separately identifiable service on the same day. However, a transmittal from CMS indicates that the modifier 25 should only be used with procedures that carry a global fee (see www.cms.gov/Transmittals/downloads/R954CP.pdf). Since that is not the case for the continuous bronchodilator codes, modifier 25 is not necessary. Some private payers, however, may require its use.