When coding for spirometry testing, it is necessary for you to know the difference between the more common coding options. You should always ask that one important question that can turn your selection process into a success: ‘Which of the spirometry codes do I need to include in my claim, and which of them should I get rid of?”
Here’s a scenario: An established patient presents to the office for a follow-up visit experiencing mild dyspnea where she was given a nebulizer or inhaler treatment. The pulmonolist also evaluates the patient’s respiratory status at that visit to determine the cause for dyspnea.
Do not leave out the possibility of reporting 94664. Sometimes patients who use inhalers on a regular basis need to learn how to use the device properly. If the staff ran a demon on how to use it the right way, you have the option to report 94664.
Here’s an example: A pulmonolist implements a care plan for a patient with asthma using Advair Diskus, an ‘aerosol generator’. After this, a nurse shows the patient how to use the device:
You should report 99201-99215 for the office visit and 94664 — minus a modifier.
Modifier 25 is not important when reporting 94664 with an office visit as CMS indicates that this modifier applies only to E/M services carried out with procedures that carry a global fee. CPT code 94664 doesn’t have a global fee.
Safety measure: Since some payers would still/ need appending modifier 25 to an E/M when carried out with 94664, it is important that you check with insurers about their policy. The medical staff may administer a medication dose to a patient during the teaching session. In this instance, you should report the most comprehensive service. When dose is administered as part of a demonstration, its intent without a doubt is to teach the patient. Therefore, reporting 94664 is more apt. When the intent is to deliver a medication dose to someone who’s having trouble breathing, go for 94640 instead.
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