Pulmonology Coding Alert

Question: An established patient with emphysema presents the office complaining of shortness of breath. The pulmonologist provides inhalation treatment, and simultaneously trains the patient on using the nebulizer at home, and provides an expanded problem-focused examination and medical decisionmaking of low complexity. What code should we report?

Answer: You should consider two CPTs to report this service. First, you would bill 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]) to cover the comprehensive service the physician provided.

Why: 94640 is your best bet since the physician's primary intent was to treat the obstruction. Reporting 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device) would risk you a denial.

For the office visit, you should report 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...) based on your documentation of an expanded problem-focused exam with lowcomplexity decision-making. You might need to append modifier 25 to 99213 to indicate that the E/M service was significant and separately identifiable from 94640.

Tip: Though technically not required, it may help to link separate diagnosis codes to the E/M and the nebulizer treatment. For instance, you could link 786.05 (Shortness of breath) to 99213, and link the emphysema code (492.8, Other emphysema) to 94640.