CPT code and Description
- 94640 – Pressurized or non-pressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device.
(For more than 1 inhalation treatment performed on the same date append modifier 76)
- 94644 – Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (For services of less than 1 hour, use 94640)
- 94060 – Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration
(Do not report 94060 with 94150, 94200, 94375, 94640, 94728)
(Report bronchodilator supply separately with 99070 or appropriate supply code) - 94070 – Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (e.g., antigen[s], cold air, methacholine.
(Report antigen(s) administration separately with 99070 or appropriate supply code)
(Do not report in conjunction with 94640)
Payment and Coding Rules
- Code all diagnosis with highest level specificity.
- CPT code 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
- For continuous aerosol inhalation treatment applied for an acute obstruction of the airway report 94644 for the first hour of treatment and 94645 for each additional hour.
- CPT code 94664, Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device does not include the services described by code 94640. If the services described in 94664 performed in addition to the nebulizer administration, code it if medically necessary and is not overlapping with nebulizer administration.
- Evaluation and management code can be reported if significant, separately identifiable evaluation and management service provided by the same physician.
- Always code green rain code for the unit of drug administered in addition to the nebulizer treatment CPT code.
Example 1
Question: A 4 year old asthmatic girl holding a Thiqa card presents to family physician with cough, shortness of breath and wheeze. Physician diagnosed it as asthma exacerbation and two nebulizer treatments with ATROVENT 0.025% is given .She clears up and breathing is easier, and evidently better.
Answer:
Nebulizer administration – 94640 X 2 times
Nebulizer Medication – 1317-1289-001
. Pulmonary Services
- CPT code 94640 (pressurized or non-pressurized inhalation treatment for acute airway obstruction…) describes either treatment of acute airway obstruction with inhaled medication or the use of an inhalation treatment to induce sputum for diagnostic purposes. CPT code 94640 should only be reported once during an episode of care regardless of the number of separate inhalation treatments that are administered. If CPT code 94640 is used for treatment of acute airway obstruction, spirometry measurements before and/or after the treatment(s) should not be reported separately. It is a misuse of CPT code 94060 to report it in addition to CPT code 94640. The inhaled medication may be reported separately.
- CPT code 94640 (pressurized or non-pressurized inhalation treatment for acute airway obstruction…) and CPT code 94664 (demonstration and/or evaluation of patient utilization of an aerosol generator…) generally should not be reported for the same patient encounter. The demonstration and/or evaluation described by CPT code 94664 is included in CPT code 94640 if it utilizes the same device (e.g., aerosol generator) that is used in the performance of CPT code 94640.
If performed at separate patient encounters on the same date of service, the two services may be reported separately.” (CMS6)
“Routine supplies are items used during the normal course of treatment, which are directly related to and/or integral to the performance of separately payable therapy, treatments, procedures, or services. These supplies are customarily used during the course of treatment and are normally found in the floor stock, which are generally used by all patients in that specific area/or location.”
Inhaler Technique 94640 Breathing treatment BILLING TIPS
• The documentation in the patient’s medical record should provide rationale for providing the patient education related to bronchodilator administration, and should include comments about the patient’s ability to correctly use the delivery device.
• Do not bill separately for the breathing treatment (94640) that is administered at the time the evaluation or demonstration of the device is provided.
• To bill both 94640 and 94664 on the same date of service, there must be documentation supporting that the procedures were separate and distinct from one another. The medical record should include a request for each procedure, and therapist documentation should support that procedures occurred at separate times.
- CPT code 94060 (bronchodilation responsiveness, spirometry as in 94010, pre- and post- bronchodilator administration) describes a diagnostic test that is utilized to assess patient symptoms that might be related to reversible airway obstruction. It does not describe treatment of acute airway obstruction. CPT code 94060 includes the administration of a bronchodilator. It is a misuse of CPT code 94640 (pressurized or non-pressurized inhalation treatment for acute airway obstruction…) to report 94640 for the administration of the bronchodilator included in CPT code 94060. The bronchodilator medication may be reported separately.
- CPT code 94640 (pressurized or non-pressurized inhalation treatment for acute airway obstruction…) describes either treatment of acute airway obstruction with inhaled medication or the use of an inhalation treatment to induce sputum for diagnostic purposes. CPT code 94640 should only be reported once during a single patient encounter regardless of the number of separate inhalation treatments that are administered. If CPT code 94640 is used for treatment of acute airway obstruction, spirometry measurements before and/or after the treatment(s) should not be reported separately. It is a misuse of CPT code 94060 to report it in addition to CPT code 94640. The inhaled medication may be reported separately.
- CPT code 94640 (pressurized or non-pressurized inhalation treatment for acute airway obstruction…) and CPT code 94664 (demonstration and/or evaluation of patient utilization of an aerosol generator…) generally should not be reported for the same patient encounter. The demonstration and/or evaluation described by CPT code 94664 is included in CPT code 94640 if it utilizes the same device (e.g., aerosol generator) that is used in the performance of CPT code 94640. If performed at separate patient encounters on the same date of service, the two services may be reported separately
