Pulmonology Coding Alert

Question: What codes should I report when a patient presents with acute exacerbation of extrinsic asthma? A nurse administers albuterol using a metered-dose inhaler under the pulmonologist's supervision.

Oklahoma Subscriber

Answer: You should report 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]) for the nebulizer treatment.
 
The proper diagnosis code is 493.02 (Extrinsic asthma; with [acute] exacerbation).
 
If you want to report the albuterol, you should list the appropriate J code, such as J7613 (Albuterol, inhalation solution, administered through DME, unit dose, 1 mg).
 
Snag: Medicare considers 94640's reimbursement to cover the drug charge. Private insurers may pay separately for the drug.
 
Watch for: Because the nurse, not the physician, provided the nebulizer treatment, be sure the encounter meets "incident-to" requirements. This means that the supervising pulmonologist must be physically present in the same office suite and immediately available to assist.