Pulmonology Coding Alert

Question: A patient presented to our pulmonology clinic with an exacerbation of their moderate persistent asthma. The pulmonologist administered an inhalation treatment for the asthma exacerbation, and then taught the patient how to use their recently prescribed metered dose inhaler (MDI) with addition of an aerochamber on the same date of service (DOS).

What CPT^® codes should we assign for this visit?

Texas Subscriber

Answer: You should be able to collect for both services as long as the medical documentation shows that each service was separate and necessary for treatment. You’ll assign 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) for the inhalation treatment and you’ll use 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device) to report the MDI demonstration.

You’ll also need to append modifier 59 (Distinct procedural service) to one of the codes to indicate the second procedure was separate from the first. Some payers may allow you to append modifier 59 to either code in the edit pair, whereas other payers require you to append modifier 59 only to the column 2 code.

The National Correct Coding Initiative (NCCI) edit pair lists 94664 as a column 2 code in the 94640/94664 pairing. This means that you should append modifier 59 to 94664. Of course, it’s best to double check with your individual payer preferences to see which code should receive modifier 59 or even if you should use one of the X{EPSU} modifiers, such as XU (Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service).

In summary, your claim should have the following CPT^® codes listed:

• 94640
• 94664-59 or 94664-XU