Pulmonology Coding Alert

Question: If the physician provides an office visit and then separately performs demonstration or evaluation of a nebulizer or metered dose inhaler, can we bill separately for the office visit and demonstration with modifier -25 on the E/M code?

Tennessee Subscriber

Answer: Code 94664 is for the demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device. This service does not involve any work on the part of the physician. This service represents work that qualified staff (that is, a registered nurse or physician assistant) can perform. If a physician performs a separate evaluation and management service apart from the nebulizer education/demonstration, you can report the appropriate patient visit (9920x, ... new patient; 9921x, ... established patient; or 9924x ... consult) in addition to the nebulizer demonstration/evaluations (94664).

The "global status" XXX is assigned to 94664 in the Physician Fee Schedule. This means that the global package does not apply. You do not have to append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) when reporting the office visit. However, documentation in the medical record must support the two separate services.

-- Answers for You be the Coder and Reader Questions were reviewed by Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia; and Alan L. Plummer, MD, professor of medicine, division of pulmonary, allergy and critical care at Emory University School of Medicine in Atlanta.