Pulmonology Coding Alert

Question: The pulmonologist in our practice saw an established patient who was experiencing an acute exacerbation of their moderate persistent asthma. Once the patient’s condition was stabilized, the physician reviewed the patient’s current medication with the patient. After a discussion, the physician changed the patient’s home medication therapy to 1 mg albuterol delivered by a nebulizer, which the pulmonologist administered and demonstrated during the visit.

How should I report this encounter?

Michigan Subscriber

Answer: You’ll start by assigning 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.) to report the evaluation and management (E/M) visit. The provider required a moderate level of medical decision making (MDM) because the patient experienced an exacerbation of their asthma, which falls under the exacerbation of a chronic illness complexity addressed at the encounter. The physician also adjusted the patient’s prescription, which falls under the risk of morbidity column on the elements of MDM table.

Next, you’ll assign 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/ or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device) to report the patient’s inhalation treatment during the visit. Since the treatment was in addition to the E/M visit, you’ll append 99214 with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to indicate the E/M was a separate service.

You can then report J7613 (Albuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, 1 mg) to indicate the albuterol administration during the encounter. Because the treatment and demonstration of the albuterol inhalation occurred at the same time, you would not report 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device). According to the National Correct Coding Initiative (NCCI), 94664 bundles into 94640 and can only be unbundled under certain condition (eg, demonstration of a new inhaler not administered during the visit).

Lastly, you’ll need to report the correct asthma diagnosis code to support the codes listed above. In the ICD-10-CM Alphabetic Index, search for Asthma > moderate persistent > with exacerbation (acute), which directs you to J45.41 (Moderate persistent asthma with (acute) exacerbation). You’ll then verify the code in the Tabular List..