Question: A patient with acute asthma requires three same-visit
nebulizer treatments to control his asthma. Should I bill 94640 and
J7613 multiple times, one time, or one time with a modifier for each
additional treatment?
Washington Subscriber
Answer: When a patient receives multiple aerosol treatments on the same date, you should use 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 the first treatment.
Catch: Subsequent treatments will require modifier 76 (Repeat procedure by same physician), according to CPT.
Therefore, you would code the example of three nebulizer treatments as:
94640 - first treatment
94640-76 x 2 - two subsequent treatments.
For the inhalation solution, you should report three units of J7613 (Albuterol, inhalation solution, administered through DME, unit dose, 1 mg). Because J7613 represents one "unit dose," you should report per nebulizer treatment or, in your case, J7613 x 3. If the internist meets the criteria for reporting an E/M code, you should report the appropriate-level E/M code (such as 99214, Office or other outpatient visit for the evaluation and management of an established patient ...) as well.
If the physician performs and documents a significant, separate E/M from the treatment (94640), append the E/M code with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).
Washington Subscriber
Answer: When a patient receives multiple aerosol treatments on the same date, you should use 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 the first treatment.
Catch: Subsequent treatments will require modifier 76 (Repeat procedure by same physician), according to CPT.
Therefore, you would code the example of three nebulizer treatments as:
94640 - first treatment
94640-76 x 2 - two subsequent treatments.
For the inhalation solution, you should report three units of J7613 (Albuterol, inhalation solution, administered through DME, unit dose, 1 mg). Because J7613 represents one "unit dose," you should report per nebulizer treatment or, in your case, J7613 x 3. If the internist meets the criteria for reporting an E/M code, you should report the appropriate-level E/M code (such as 99214, Office or other outpatient visit for the evaluation and management of an established patient ...) as well.
If the physician performs and documents a significant, separate E/M from the treatment (94640), append the E/M code with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).
This is a great article. I’ve read in many other places before that but
ReplyDeleteI did not get this type of effective and more useful text. It is really important now to
vary your anchors as this seems more natural to user.
This article helped me a lot to understand information.