Inhaler Education Claims: 4 Quick Guidelines to Help You Report Correct Claims

When reporting inhaler service, you should remember the type of device the provider is using, but shouldn’t stop with just that. Documentation requirements and qualifying modifiers are just as important when coding for inhaler services.

When you’re confused why some payers would deny reimbursement for certain inhaler claims, the following ideas could guide you to a better understanding of how inhaler service codes work out.

94664 Is Your Ticket to Diskus Demo Pay

The Advair Diskus is an “aerosol generator.” If the nurse/medical assistant taught someone to use an Advair Diskus — or any other diskus — you should report 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device).

For example, a pulmonologist starts a patient with asthma (493.00, Extrinsic asthma; unspecified or 493.20, Chronic obstructive asthma; unspecified) on Advair. A nurse then teaches the patient how to use the Diskus. As per CPT guidelines, you should report 99201-99215 for the office visit and 94664 without a modifier, says Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta.

In addition, 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.

Nonetheless, many payers will only pay for the service if you append modifier 25 to the visit code. It’s always best to check with your major insurers’ policy first.

Bundle Dose in Teaching Session

The patient may administer medication dose during the teaching session. Both services (treatment + teaching) are bundled into one CPT: 94640 (Pressurized or nonpressurized inhalation treatment for acute...

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4 Tips Help You Ensure Inhaler Service Success

Often a nurse or medical assistant helps a patient with an inhaler demo or evaluation, but whenever coding it, you must keep these three areas in mind: the type of device used, documentation requirements, and qualifying modifiers. Follow these four tips from our experts to understand why some payers might deny payment for the service — and what you can do to win deserved dollars.

1. Categorize the Diskus Correctly

Many physician offices use the Advair Diskus for their patients, which is an aerosol generator. “An aerosol generator is a device that produces airborne suspensions of small particles for inhalation therapy,” explains Peter Koukounas, owner of Hippocratic Solutions medical billing service in Fairfield, N.J. If the nurse or medical assistant taught someone to use an Advair Diskus — or any other diskus — you should report 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device).

The physician starts a patient with asthma (493.00, Extrinsic asthma; unspecified or 493.20, Chronic obstructive asthma; unspecified) on Advair. A nurse then teaches the patient how to use the Diskus. According to CPT guidelines, you should report 99201-99215 for the office visit (depending on whether you’re treating a new or established patient). Then report 94664, but don’t append a modifier, says Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta.

CMS transmittal R954CP 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 have a global fee period. Code 94664 does not have a global fee period, which is why you don’t automatically include modifier 25.

Despite what CMS guidelines might...

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Watch Changes to EEG, Joint Injection Guidelines

You report several EEG codes such as 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes) and 95813 (… greater than 1 hour) based on the amount of recording time. But what constitutes recording time?

Jeffrey Cozzens, MD, professor and chair of the neurosurgery division of Southern Illinois University School of Medicine and a presenter at the AMA’s CPT and RBRVS 2011 Annual Symposium in Chicago, addressed the issue during his presentation about neurosurgery and neurology changes for 2011. Keep two things in mind when calculating recording time for these EEGs:

  • Recording time is when the recording is underway and the healthcare provider is collecting data.
  • Recording time excludes set-up and take-down time.

Other EEG codes, however, focus on the amount of physician time rather than recording time. Watch for that specificity in guidelines for 95961 (Functional cortical and subcortical mapping by stimulation and/or recording of electrodes or brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of physician attendance) and +95962 (… each additional hour of physician attendance [List separately in addition to code for primary procedure). If the physician is in attendance for a total of 30 minutes or less, only report 95961 and append modifier 52 (Reduced services) to indicate he didn’t fulfill the full hour represented by the code.

Two codes for special EEG tests now specify who attends during the procedure:

  • 95953 -- Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic (EEG) recording and interpretation, each 24 hours, unattended
  • 95956 -- Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, electroencephalographic (EEG) recording and interpretation, each 24 hours, attended by a technologist or nurse.

According to information on the...

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Employ Modifier 53 For Discontinued Anesthesia Services

Pain management specialties might make use of modifier 52 as well.

The situation is bound to happen: A patient undergoing surgery has complications, and your anesthesiologist must stop his services. Are you prepared to recognize a situation that calls for...

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