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Pulmonology Coding Alert

You Be the Coder:

Before Coding 94664, Check Off These Items

Published on Mon Feb 23, 2009

Question: Under the direction of my pulmonologist I recently submitted 94664 for reimbursement for training time, but the bill was rejected? Can I challenge this?

Louisiana Subscriber

Answer: You can challenge training denials,provided your documentation supports the education's reason. However, "not all payers will pay for 94664,"notes Gary N. Gross, MD, executive vice president of the Joint Council of Allergy, Asthma & Immunology.

If practices abuse the code, probably fewer payers will pay the approximately $14.80 national rate (0.41 transitional nonfacility total relative value units X $36.0666 conversion factor for 2009 = $14.79).

Solution: To support reporting 94664, documentation should include an indication of medical necessity, Gross stresses. The physician should state in the chart's plan or treatment portion two items: that the patient requires a teaching session on the use of his MDI, discus, nebulizer, etc., and why the session is needed. A statement could read, "The patient did not demonstrate the proper use of his MDI."

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