Pulmonology Coding Alert

Question: A known asthmatic patient presented with acute breathlessness. The provider administered inhalation treatment. Can we bill both 94640 and 94644 on the same day for inhalation treatment for acute airway obstruction? The patient needed multiple short inhalation treatments on the same day. Please advise.

Texas Subscriber

Answer: When providing inhalation treatment for acute airway obstruction, Medicare will not pay for both 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) and 94644 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour) if they are billed on the same day for the same patient, according to the American Association for Respiratory Care AARC guidelines (https://www.aarc.org/app/uploads/2014/10/coding_guidelines.pdf)

You will have to decide which of the two codes to submit for payment. Generally, you will choose the code that represents the time and service provided. No matter how many inhalation treatments your provider administers to the patient, you would report CPT^® code 94640 only once during a single patient encounter, according to AARC guidelines. This applies to outpatient facility claims.

However, if there are multiple separate patient encounters for inhalation therapy on the same date of service, you may report the additional encounters for inhalation therapy with modifier 76 (Repeat procedure or service by same physician or other qualified health care professional). Physician offices can clarify that they are still able to report a repeat administration with an appropriate modifier 76 or 59 (Distinct procedural service).

Caution: CMS’s Medically Unlikely Edits (MUE) warn that you may not report more than two single encounters for inhalation therapy per day.