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Follow
These Coding Do’s on Inhalation Service Claims
From
Family Practice
Coding Alert, 2008, Vol. 10, No. 8
Code 94664 describes 4 devices, but
that’s not a complete list
Stop missing
opportunities to capture 94664 service -- or coding it when you
shouldn’t -- by getting the lowdown on the pulmonary service’s
qualifying devices, documentation requirements, and payment obstacles.
Do: Classify
Advair Diskus Demo as 94664
Should you use
94664 for education/training with the Advair diskus? asks Jen
Krohn, CPC, CCP, coding specialist at Waukesha Health Care
Inc. in Wisconsin.
Code 94664
(Demonstration and/or evaluation of patient utilization of an aerosol
generator, nebulizer, metered dose inhaler or IPPB device) "would seem
appropriate to use for [Advair diskus] demonstration and evaluation,"
says Gary N. Gross, MD, executive vice president of
the Joint Council of Allergy, Asthma & Immunology (JCAAI).
Why:
The Advair Diskus is an "aerosol generator," says Alan L. Plummer, MD,
professor of medicine, Division of Pulmonary, Allergy, and Critical
Care at Emory University School of Medicine in Atlanta. Therefore,
"teaching someone to use an Advair (or any other) diskus does fall
under 94664."
Example:
The FP starts a patient with asthma (493.00, Extrinsic asthma;
unspecified) on Advair. A nurse then teaches the patient how to use the
diskus. You should report 99201-99215 for the office visit and 94664
without a modifier, according to CPT guidelines, Plummer says.
CMS transmittal
R954CP also indicates that modifier 25 (Significant, separately
identifiable E/M service by the same physician on the same day of the
procedure or other service) applies only to E/M services performed with
procedures that carry a global fee, which 94664 does not have.
Beware:
Before dropping modifier 25 from 99201-99215 with 94664, check with
your major insurers. "Some payers may require modifier 25 appended to
the E/M when performed with 94664 or any ‘pulmonary’ service," says Carol
Pohlig, BSN, RN, CPC, ACS, senior coding and education
specialist at the University of Pennsylvania department of medicine in
Philadelphia.
This
increasingly common use of modifier 25 is acceptable if the payer
requires it. Get this requirement in writing or e-mail from the payer.
Do: Include Dose
in Teaching Session
During the
teaching, the patient may receive a medication dose. In this case,
Pohlig says, you should not separately report the treatment (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]).
Reason: The
administration "was performed as part of the demonstration/evaluation,
and the service’s intent was patient teaching," Pohlig says.
Do: Code for
Separate Education With 59
But if the
reverse occurs and the patient requires separate education after
receiving an inhalation treatment, you may be able to bill both
services. "Typically, code 94640 does not include patient education,"
writes Steve G. Peters, MD, FCCP, in "Continuous Bronchodilator
Therapy" published in the American College of Chest Physicians’ Chest
(2007; 131; 286-289).
"If separate
medication instruction occurs on the same day as an initial aerosol
treatment (e.g., a different form of inhaler requiring education), code
94664 can be used with a 59 modifier to indicate the distinct
procedural service," explains Peters, of the department of internal
medicine, Division of Pulmonary and Critical Care Medicine at the Mayo
Clinic in Rochester, Minn.
From Family
Practice Coding Alert, 2008, Vol. 10, No. 8
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