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Pulmonology Coding Alert

Reader Question:

Inhalation Therapy

Published on Mon Oct 01, 2001

Question: Im confused about inhalation therapies. Which codes specifically apply to which treatments and therapies?

Idaho Subscriber
 
Answer: Typically, correct coding for therapeutic aerosol inhalations would be 94640 (nonpressurized inhalation treatment for acute airway obstruction). Code 94640 also allows you to bill for the drug used in the treatment, such as albuterol, J7619.
 
If the bronchodilator treatment is repeated, append modifier -76 (repeat procedure by same physician) to 94640 on the subsequent line items for 94640. Codes 94664 (aerosol or vapor inhalations for sputum mobilization) and 94665 (... subsequent) can be used when a bronchodilator is administered for diagnostic purposes. The patient may need to move thick secretions or mobilize sputum in order to produce a specimen for culture or gram stain. Codes 94664-94665 can also be used during evaluation.
 
To train the patient on the use of a new type of equipment such as a metered-dose inhaler, a healthcare professional administers the medication to the patient and gives instructions. The patient is observed and evaluated to ensure appropriate use. Code 94664 is used for the initial demonstration/evaluation, and 94665 is used for subsequent demonstrations/evaluations.
 
It is important to check with your carrier regarding the proper reporting of 94664. Most insurers allow this code to be reported only once (in a lifetime) per patient.
 
Use E/M codes (99201-99215 for outpatients, 99221-99236 for inpatients) with the nebulizer codes (94640 and 94664-94665, the latter two depending on the intent of the therapy -- treatment of acute obstruction or demon-stration, for example). If a separately identifiable E/M service was performed on the same day, add modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).
 
Other problems may occur with 94640 when it is billed with 94070 (prolonged postexposure evaluation of bronschospasm with multiple spirometric determinations after antigen, cold air, methacholine or other chemical agent, with subsequent spirometrics).
 
For instance, a reaction to the test would lead to administration of albuterol, which could lead to rejection of 94640, even when accompanied by the -59 modifier (distinct procedural service), since some insurance providers will say nebulizer treatments should be included in 94070.
 
When billing nebulizer treatments, be certain the patients medical record clearly illustrates medical necessity. This includes a physicians orders, plans of treatment, the patients response to treatment, and ongoing assessments.

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