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Family Practice Coding Alert

Break Down Nebulizer Session to Capture Allowable Services and Procedures

Although CPT 2003 clarified the nebulizer training codes, family practice coders are still asking questions regarding how to report nebulizer sessions. By understanding how to code each service and recognizing that payer policies vary, you can bill these procedures and services with confidence. Family practitioners (FPs) often treat patients for wheezing and difficulty breathing due to asthma, lung disorders or upper respiratory infections. These office visits can take a lot of time because they encompass many services, including patient history, examination and medical decision-making, and procedures, such as spirometry, bronchodilation and training. This article focuses on the initial procedures. For nebulizer training and E/M coding issues, see next month's Family Practice Coding Alert. Understand a Typical Session During a typical session, a patient presents to an FP's office for wheezing (786.07). The physician reviews the patient's history and examines the patient, concentrating on the lungs, upper airways, eyes, ears, nose (particularly the nasal passages) and throat.

The physician cannot evaluate the airways from the examination alone, so he performs pulse oximetry and uses a spirometer to measure pulmonary function. He administers a bronchodilator to the patient, followed by another pulse oximetry measurement and spirometry. He then compares the before and after readings to assess the bronchodilator's success. The patient continues to exhibit respiratory symptoms, so the FP administers a second bronchodilation followed by spirometry. The pulmonary reading shows that the patient's symptoms are subsiding. The doctor prescribes an inhaler and a spacer for the individual. Anurse demonstrates how to use the inhaler.

The physician and nurse perform seven procedures:

1. pulse oximetry x 2
2. spirometry before and after bronchodilation x 2
3. bronchodilation x 2
4. training;
and two services:
1. established patient office visit
2. emergency service. Bill Private Payers for Pulse Oximetry Coverage for pulse oximetry (e.g., 94760, Noninvasive ear or pulse oximetry for oxygen saturation; single determination) depends on the payer. Medicare announced in January 2000 that it would no longer cover 94760 unless it is the only procedure provided. This means that if you bill any other code on that day, you cannot bill pulse oximetry as well because Medicare has bundled the oximetry codes into every other CPT code. If you perform pulse oximetry and nothing else, that is the only time you can bill and get paid for this procedure.

Carriers view pulse oximetry as similar to taking a patient's temperature. "Pulse oximetry is no more invasive and arguably less invasive than recording the patient's temperature, another example of a diagnostic service for which we do not make [...]