Pulmonology Coding Alert

Question: I have an emergency department (ED) report for an encounter with a patient experiencing an acute exacerbation of their moderate persistent asthma. The physician provided two inhalation treatments with a metered dose inhaler, and then the physician administered continuous treatment for approximately 105 minutes.

I’m new to pulmonology coding, but think I should report 94644 and +94645 for this case. Am I correct?

Texas Subscriber

Answer: You are correct! You’ll assign 94644 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour) and +94645 (… each additional hour (List separately in addition to code for primary procedure)) to report the continuous inhalation treatments. Since the physician provided the continuous inhalation treatments for approximately 105 minutes — or 1 hour and 45 minutes — 94644 accounts for the first hour of treatment and +94645 represents the additional time past the first hour.

Coders may want to also code 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 represent the metered dose inhaler treatments, but reporting 94640 in this case may be incorrect.

According to the Medicare National Correct Coding Initiative [NCCI] 2022 Coding Policy Manual, Section J.8, “If inhalation drugs are administered in a continuous treatment or a series of ‘back-to-back’ continuous treatments exceeding one hour, CPT® codes 94644 and +94645 may be reported instead of CPT® code 94640” (www.cms.gov/files/document/chapter11cptcodes90000-99999final11.pdf). Of course, you should check your individual payer preferences as they may differ from Medicare policies.

Don’t ignore ICD-10-CM: The physician diagnosed the patient with an acute exacerbation of the patient’s moderate persistent asthma, so you’ll assign J45.41 (Moderate persistent asthma with (acute) exacerbation) to report the diagnosis.