Otolaryngology Coding: Four Easy Guidelines To Profit $16 From 94664

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Remember that while reporting for inhaler demo/evaluation is the type of device the provider is using; however do not stop with just that. Documentation requirements and qualifying modifiers are just as important while coding for inhaler services.


When you are confused why some payers would reject your payments for certain inhaler claims, the following areas could teach you to a better understanding of how inhaler services work out.


94664: Your ticket to Diskus Demo Pay


The Advair Diskus happens to be an "aerosol generator"; if the nurse or for that matter medical assistant taught someone to use an Advair Diskus -- or any other diskus - you should code 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device).


Here's an instance: A pulmonologist begins a patient with asthma on Advair. Post this, a nurse teaches the patient ways to use the Diskus. According to CPT guidelines, you should code 99201-99215 for the office visit and 94664 minus a modifier.


...
... What's more, CMS transmittal R954CP also points out that modifier 25 (Significant, separately identifiable Evaluation/Management service by the same physician on the same day of the procedure or other service) applies only to Evaluation/Management services carried out with procedures that carry a global fee, which 94664 doesn't have.


Nevertheless, many payers will pay for the service only if you add modifier 25 to the visit code. It is always best to check with major insurers' policy first.


Bundle dose in teaching session


During the teaching session, the patient may administer medication dose. Both services (treatment + teaching) are bundled into one CPT: 94640 so you should not report them separately.


The reason is that the administration was carried out as part of the demonstration/evaluation.


In case of separate education, end it with modifier 59


Think that during an outpatient visit, an asthmatic patient is wheezing and having trouble breathing, which requires one or more bronchodilator treatments for intervention: 493.01 (Extrinsic asthma; with status asthmaticus); 493.02 (Extrinsic asthma; with [acute] exacerbation); 493.21, (Chronic obstructive asthma; with status asthmaticus); or 493.22 (Chronic obstructive asthma; with [acute] exacerbation).


The patient did not use his MDI device, nebulizer, and the like, properly before the visit; as such he was given an education about the use of these devices post the treatment.


Report it: At the outset, code 94640 (adding modifier 76, Repeat procedure or service by same physician, to separate line items of 94640 for multiple treatments) apart from the proper E/M code minus a modifier, unless the payer needs modifier 25 with the Evaluation/Management. The code 94664 with modifier 59 (Distinct procedural service) since the patient needed additional instruction for his daily medication.


This is unlike the medication provided for immediate intervention (94640).


In a nutshell, if the patient required separate education after getting an inhalation treatment on the same day, you'd bill both services (treatment and education) adding modifier 59 to 94664.


Pocket $16 through medical necessity support


If payers wouldn't reimburse your 94664 claim, you'd need to support it with documentation indicating medical necessity to compensate around $16 national rate (0.47 RVUs multiplied by 2011 conversion factor of 33.9764). For example, you might need to state in the plan of treatment portion of the written record that the patient needs a teaching session on the use of his MDI, diskus, nebulizer, and the like. What's more, do not forget to write down why the session is required.


For more on this and for other specialty-specific articles to assist your otolaryngology coding, sign up for a good medical coding resource like Coding Institute.