Pulmonology Coding Alert

Question: If I understand correctly, when the pulmonologist or ancillary staff show a patient how to use a metered-dose inhaler or nebulizer, we can report 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered- dose inhaler or IPPB device). In that case, what documentation should we supply to prove that the physician or staff provided the educational work?

New Jersey Subscriber


Answer: As described in CPT, you should report 94664 to represent the demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered-dose inhaler or IPPB device. The documentation may include details on the device the physician demonstrated or observed, patient comprehension, accuracy and appropriateness of utilization, educational issues addressed, and patient response. Medicare and private payers require that the pulmonologist or nurse (whoever demonstrated the nebulizer or inhaler) sign the documentation.
 
Remember that insurers consider 94664 a component of 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). So, if you report 94640, you cannot also list 94664 and expect payment if the pulmonologist performed the two procedures on the same patient and on the same day.
 
For example, the pulmonologist provides the patient with a breathing treatment, such as a nebulizer, to relieve symptomatic airway obstruction, and instructs the patient on how to use the nebulizer at home. You would report only 94640 for the treatment, which also includes the training. But if the patient only needed a review of educational issues concerning nebulizer use, you could use 94664.