Pulmonology Coding Alert

Question: Our pulmonologist recently assessed a patient with complaints of shortness of breath. After examination and running through several tests, he determined it was related to the patient's emphysema caused by habitual use of tobacco. Our pulmonologist provided inhalation using a nebulizer and instructed the patient on the use of the nebulizer. What codes should I use to report the services provided by our pulmonologist?

New Mexico Subscriber

Answer: Since your pulmonologist evaluated the patient through history and interpretations of tests, you will need to choose the appropriate E/M code for the office visit (99201-99205, Office or other outpatient visit for the evaluation and management of a new patient...) for a new patient or 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient...) for an established patient. You will also need to append the modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code that you are reporting.

You should report the treatment with the nebulizer using 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]).

Do not report 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device) for the instructions provided on the use of the nebulizer in addition to 94640. As per Correct Coding Initiative (CCI) edits, 94664 is a column 2 code for 94640 and should not be reported separately. Here the training services get incorporated into the treatment code and should not be reported separately.

However, if the demonstration was a separate service that was provided and was not part of the treatment (e.g., demonstration of a different inhaler system to be used at home) you can report 94664 separately. But as 94664 is a column 2 code for 94640, you will need to append the modifier 59 (Distinct procedural service) to 94664 to notify the payer that the services were separate. You will also need to provide adequate documentation that separates the instructions from the treatment and include details on the medical necessity of providing this service.

Do not forget to report the symptoms with 786.05 (Shortness of breath) and the diagnosis of emphysema with 492.8 (Other emphysema) to enable the payer to know the medical necessity of the services provided by your pulmonologist.