Pulmonology Coding Alert

Question: Is there a code for instructing a patient on using a nebulizer?

Ohio Subscriber

Answer: Code 94664 (aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes; initial demonstration and/or evaluation) is the correct code.

According to information published in the February 1996 and May 1998 issues of the American Medical Associations CPT Assistant, 94640 is used to report a nonpressurized inhalation treatment given for an acute airway obstruction, e.g., status asthmaticus. It should not be used to report a demonstration of aerosol or vapor inhalation treatments for educational purposes.

Code 94664 should be used for the initial demonstration and/or evaluation of aerosol or vapor inhalations for sputum mobilization, bronchodilation or sputum induction for diagnostic purposes. Code 94664 best describes teaching the patient to use the nebulizer for bronchodilation or sputum mobilization.

Many medical practices are reporting that several payers do not cover this code. If it is a significant portion of your practice, consider negotiating a set amount with your payers for this service and setting up payer-specific codes to use for the reimbursement. But be sure to get such agreements in writing because if your claim is denied, you can refer to the written agreement during the appeal process.

Answered by Lane Rierson, CPC, a certified healthcare compliance consultant for Health Care Consulting in Greensboro, N.C.