Pulmonology Coding Alert

Question: An asthmatic patient presents with complaints of wheezing and difficulty in breathing. This patient honestly informs that she didn’t use her MDI device or nebulizer properly prior to her visit. The provider decides that she requires one or more bronchodilator treatments for intervention. He also provides her with additional education about how to use the devices. How do we report this scenario?

Utah Subscriber

Answer: You could report 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device). Another code that may seem useful is 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device). However, both these codes are bundled, and only if documentation supports separate services can you report 94664 with modifier 59 (Distinct procedural service).

Note: Situations that support the decision to use modifier 59 occur when services are provided at separate sessions on the same day, when they are performed on separate sites, or when they are performed for separate and distinct reasons that do not overlap (for example, the information cannot be derived from the initial procedure or service). Be sure your documentation supports using modifier 59.

Remember: Some payers have their own rules about situations when they allow you to report codes together.