Pulmonology Coding Alert

Question: My pulmonologist saw an established patient who was newly diagnosed with asthma and reported still worsening symptoms. He checked the patient for medication adjustments. The pulmonologist performed a level-three E/M service and administered a nebulizer treatment. He then recommended home nebulizer therapy and instructed the patient on how to conduct home nebulizer treatments. How should I report these services?


Michigan Subscriber


Answer: For the level-three office visit, you should use 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: an expanded problem-focused history; an expanded problem-focused examination; medical decision-making of low complexity) as long as the documentation supports the charge.

You may need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99213 for some carriers. Modifier 25 indicates that the office visit was separate from the nebulizer treatment and education session. Be sure to check with your individual payers.

Submit 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes) for the nebulizer treatment that the pulmonologist or nurse performed in the office.

To code the nebulizer education, assign 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device). Be sure to append modifier 59 (Distinct procedural service) to this code to indicate that the education session was independent from the office visit. Remember that it's necessary for the physician to document the reason for and the details of the instruction.

Note: ICD-9 code 493.02 (Extrinsic asthma; with [acute] exacerbation) is an appropriate diagnosis code to report for all of these services.