Pulmonology Coding Alert

Question: When a nurse instructs a patient how to use a metered-dose inhaler (MDI) during a regular office visit, can we bill for this service separately or can we bill the E/M with modifier -25 and one of the appropriate codes (94664-94665 or 94640)?

Maryland Subscriber  
Answer: Codes 94664-94665 (aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes ...) and 94640 (nonpressurized inhalation treatment for acute airway obstruction) are complete codes, meaning they cannot be divided into technical and physician components. If a physician or a member of the office staff performs the service, it can be recorded as a stand-alone service, or in addition to an E/M service with a modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). You will be reimbursed for all the charges associated with these codes, which contain multiple components. Therefore, if an E/M service is provided by a physician on the same date, the physician should report the service provided using the appropriate E/M code (99201-99215). It is correct coding to add modifier -25 to the E/M to identify that it was separate and identifiable from the other procedure or service provided on the same day. However, Medicare does not require it for payment at this time.