Pulmonology Coding Alert

Question: Our pulmonologist gave an inhalation treatment for an exacer­bation and taught the patient how to use a newly prescribed metered dose inhaler (MDI) with addition of an aerochamber on the same date of service. We reported 94664 and 94640-59 and the claim was denied. Can you advise?

Tennessee Subscriber

Answer: As long as the documentation supports the separateness of each service, you should be able to collect for both services. Although some payers allow you to append modifier 59 (Distinct procedural service) to either the column 1 or column 2 code in the edit pair, other payers require you to append it to the column 2 code. In this case, you appended modifier 59 to the column 1 code (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).

Instead, your payer probably wanted you to append the modifier to 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device), because the National Correct Coding Initiative (NCCI) lists it as the column 2 code in this pairing.

Action: If you notice that you have put modifier 59 on the wrong code, resubmit the claim. In the event of an audit, payers should look positively on your proactive stance. Your corrected claim should look like this:

• 94640
• 94664-59