Pulmonology Coding Alert

Sorting out which codes to apply to specific respiratory treatments and inhalation therapies can be a challenge, because several different codes relate to these procedures. Recognizing the subtle differences between them is vital to reimbursement. For example, if your pulmonology practice routinely codes 94664 (aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes; initial demonstration and/or evaluation) for bronchodilator treatment of a patient experiencing an acute bronchospasm, youre coding it incorrectly.

The correct code is 94640 (nonpressurized inhalation treatment for acute airway obstruction), says Walter J. ODonohue Jr., MD, FCCP, FACP, a representative to the AMA CPT Advisory Committee for the American College of Chest Physicians (ACCP), and chief of the pulmonary and critical care division of the Creighton University School of Medicine in Omaha, Neb. This covers aerosol or nebulized administration of medication prescribed for blocked airways, such as in asthma or croup patients. So common is the bronchodilator coding mistake that it was the subject of AMA comment in the April 2000 issue of CPT Assistant , notes ODonohue, who co-authored the article. Despite the explanation offered by the AMA, confusion over the inhalation treatment and therapy codes still persists.

Recognize 94640, 94664-94665 Differences

The primary difference between 94640, 94664 and its companion code 94665 (aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes; subsequent) is that 94640 is for treatment, and 94664/5 are for instructing patients, evaluating their technique in using the bronchodilator, and assessing effectiveness, ODonohue explains.

Codes 94664-94665 describe the following services:

Demonstrating or instructing the patient in the use of a metered-dose nebulizer or inhaler;

Bronchodilation for long-term management of bronchospasm;

Bronchodilation to move thick secretions for therapeutic purposes;

Bronchodilation to move thick secretions so the patient can produce a sputum specimen; and

Diagnostic studies, such as for culture or a gram stain test.

Also, 94664 can be used only once in the patients lifetime with a particular physician, ODonohue says. For example, if a patient has been instructed in the use of a bronchodilator, and the doctor later reinstructs the patient, the appropriate code would be 94665. If the patient changes physicians, and the new doctor demonstrates how to use the bronchodilator, he or she should report 94664.

Note: The single-use intent of 94664 has been questioned recently by pulmonology practices, and the AMA is seeking to apply it to a new, disk-shaped bronchodilator that delivers two types of medications at once. ODonohue recommends [...]