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Pulmonology Coding Alert

Reader Question: Bronchodilators and IPPB Treatments

- Published on Mon, Apr 01, 2002
Question: Whats the latest on coding for broncho-dilators and intermittent positive pressure breathing (IPPB) treatments? We heard that the CPT Editorial Panel was updating these.

Nevada Subscriber
Answer: The AMAs CPT panel has discussed these codes on three occasions in the last 18 months and still has not made final recommendations. The panel plans to complete the debate on this issue in May 2002.
Continue to report these services as instructed in the CPT manual. Use 94640 (Nonpressurized inhalation treatment for acute airway obstruction) for treatment with a nonpressurized inhalation device, such as a small-volume nebulizer, metered-dose inhaler or dry-powder inhaler. If more than one treatment is administered on the same day, then modifier -76 (Repeat procedure by same physician) should be appended. Code 94664 (Initial nebulizer treatment) is used to report initial demonstration and/or evaluation of the use of a device such as the small-volume nebulizer, metered-dose inhaler or dry-powder inhaler. The same code (94664) can also be used when these devices are used for sputum induction for diagnostic purposes. However, this code can be billed only once in a 24-hour period. Use 94665 ( subsequent nebulizer treatment) for subsequent reinstruction and demonstration of the use of these devices on another day of service.
IPPB treatments are not commonly given in doctors offices, but, if they are performed, use 94650 (IPPB initial), which is also for initial instruction and demonstration. Again, this code can be billed only once per day. Use 94651 ( subsequent IPPB) for subsequent demonstration and evaluation of the use of IPPB on another day of service.
These are complete codes they cannot be split into professional and technical components. If hospital personnel provide these services, physicians cannot bill for them. If the physician or any member of his or her staff provides them, or owns the equipment, the physician can bill for them.
  Answers to Reader Questions and You Be the Coder provided by Theresa Thompson, BS, CPC, a coding specialist in Sequim, Wash., Mary Mulholland, RN, BS, CPC, reimbursement analyst at the University of Pennsylvania department of medicine in Philadelphia; Carol Pohlig, BSN, RN, CPC, a reimbursement analyst for the Hospital at the University of Pennsylvania in Philadelphia; Walter ODonohue, MD, FCCP, FACP, chairman of the CPT committee of the American College of Chest Physicians (ACCP) and a representative to the AMA CPT advisory committee for ACCP, Omaha, Neb.; and Rona Hamill, billing specialist, Asthma and Allergy Center, Papillion, Neb.

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