Wiki 94640 In-Office Nebulizer Treatments

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Tbeechler

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We have been seeing denials from insurance companies when we see a patient and bill for an office visit with a nebulizer treatment. They are denying the office visit and paying only for the nebulizer treatment. Is anyone else having this issue? What are you doing/suggestions on what to do to get around it? Thanks!
 
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What is the level of office visit you are coding for? Is the diagnosis consistent with the medical necessity of a nebulizer tx? Are you using any modifiers?
 
We are using a 99213. Pt presented with wheezing, coughing, fever, SOB. The pulse ox warranted, along with presenting problems, the nebulizer treatment. I didn't use any modifiers as I wasn't sure which one would really apply. Mod 25 wouldn't work because of the same dx code being used.
 
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You can use mod 25. the difinition in the CPT for Modifier 25 states that " a different diagnosis is not required"
 
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