Pulmonology Coding Alert

How can we correct the claim?

Michigan Subscriber

Answer: Incentive spirometry demonstration is typically included in the physician’s E/M service. Atelectasis is a common problem in post-operative patients and those with advanced lung disease. When atelectasis occurs, deeper breaths may be helpful to re-expand the lungs. Incentive spirometers encourage expansion of the lungs as much as possible above spontaneous breathing. The use of these devices should not be confused with spirometry.

Code 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device) covers the demonstration portion of the encounter, but the code is designated for aerosol generators, nebulizers, metered dose inhalers, and intermittent positive pressure breathing (IPPB) devices. The code descriptor doesn’t include mention of incentive spirometers.

At the same time, 94014 (Patient-initiated spirometric recording per 30-day period of time; includes reinforced education, transmission of spirometric tracing, data capture, analysis of transmitted data, periodic recalibration and review and interpretation by a physician or other qualified health care professional) is reserved in the CPT^® code set to report spirometer use by the patient. This code includes reinforced education, but the code is intended to report at-home, patient-initiated spirometry over a 30-day period rather than just the demonstration.

An incentive spirometer is a medical device that patients use to help improve their lung function. A healthcare provider may order an incentive spirometer for a patient recovering from an illness, surgery, or a chest or abdomen injury. The patient inserts the mouthpiece and inhales slowly to expand their lungs. Over time and with regular use, the patient will regain the ability to take deep, full breaths rather than breathing shallowly.