Pulmonology Coding Alert

Answer: You will report these services as instructed in the CPT® manual by using 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 treatment with an inhalation device, such as a small-volume nebulizer, metered-dose inhaler or dry-powder inhaler. If you have administered more than one treatment to the patient on the same day, then you should report 94640 again and append modifier 76 (Repeat procedure by same physician). Code 94640 represents a single, short-term inhalation treatment. Some payers might not recognize modifier 76, so check individual payer rules before filing the claim. When coding for nebulizer treatments, physicians may choose either 94640 or 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device).

 

You should report 94664 to reflect demonstration and/or evaluation of the use of a device such as the small-volume nebulizer, metered-dose inhaler or dry-powder inhaler. You can also use code 94640 when the physician uses these devices for sputum induction for diagnostic purposes. For Medicare payers (and many private payers), don’t report 94640 in addition to 94644-94645 if, for example, the patient required continuous nebulizer treatment and later in the same visit, received a 10-minute aerosol breathing treatment. The national Correct Coding Initiative (CCI) bundles 94640 as column 2 code, with 94644 as the more extensive (column 1) procedure code. The code pair edit receives a “0” modifier indicator, meaning that you may not bill the codes together under any circumstances. Please remember that 94664 can be billed only once in a 24-hour period. 

 

Use 94645 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; each additional hour [List separately in addition to code for primary procedure]) in conjunction with 94644 for continuous inhalation treatment of 1 hour or more.

 

Careful: The above-mentioned codes are global codes and they cannot be split into professional and technical components. If hospital personnel provide these services, physicians cannot bill for them. The physician can bill for these services only if the physician (or any member of his or her staff) provides them, or owns the equipment.