Pulmonology Coding Alert

Question: A patient presents to the office with an allergic reaction to chlorine after swimming all afternoon. The patient is wheezing with dyspnea. The physician immediately administers a nebulizer treatment that proves slight improvement. After re-assessing the patient, the physician decides to administer another treatment in order to evoke a better therapeutic response. Can I report modifier 76?

Arizona Subscriber

Answer: Yes. You would use modifier 76 (Repeat procedure by same physician) to indicate that a procedure or service was repeated in a separate session on the same day by the same physician. You may also report this modifier for services ordered by physicians but performed by staff, when permitted. Be sure documentation reflects each service you report.

Here's what you should report on your claim:

• 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) to describe the initial nebulizer treatment
• 94640 appended by modifier 76 for the second nebulizer treatment.