Pulmonology Coding Alert

Question: In relation to the first question, in what situation should we be reporting 94664 then? The Medicare fee schedule shows it pays more than the nebulizer code. Can I bill for this?

Answer: Yes, 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device) is a valid code if a nurse or other provider shows a patient how to use a nebulizer-type device, such as an inhaler; teaches the patient proper usage including hold and dosing; or observes the patient using the device.

Important: The physician or nonphysician provider (NPP) who orders the nebulizer education should indicate the medical necessity for the service, such as incorrect handhold, new prescription, etc.

The Correct Coding Initiative (CCI) edits bundle 94664 into inhalation treatment code 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). If the education occurs while the patient receives the inhalation treatment, do not separately bill the education. If, however, the physician provides the inhalation treatment, and recommends the patient receive education for a new prescription, and the nurse subsequently performs the training, you may report 94664 with modifier 59 (Distinct procedural service).