Pulmonology Coding Alert
Append 76 for Multiple Nebulizer Treatments
Question: A patient with acute asthma requires three same-visit nebulizer treatments to control his asthma. Should I bill 94640 and J7613 multiple times, one time, or one time with a modifier for each additional treatment? For the inhalation solution, you should report three units of J7613 (Albuterol, inhalation solution, administered through DME, unit dose, 1 mg). Because J7613 represents one "unit dose," you should report per nebulizer treatment or, in your case, J7613 x 3.
Washington Subscriber
Answer: When a patient receives multiple aerosol treatments on the same date, you should submit 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 first treatment.
Catch: Subsequent treatments will require modifier 76 (Repeat procedure by same physician). "For more than one inhalation treatment performed on the same date, append modifier 76" to code 94640, states CPT's note following 94640.
Therefore, you would code the example of three nebulizer treatments as:
If the pulmonologist meets the criteria for reporting an E/M code, you should report the appropriate-level E/M code (such as 99214, Office or other outpatient visit for the evaluation and management of an established patient ...) in addition to the pulmonary procedure(s) performed, according to CPT's pulmonary subsection introductory notes.
Provided the pulmonologist performs and documents a significant, separate E/M from the treatment (94640), append the E/M code with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).
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