94640 – Pressurized or non-pressurized 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).
94664 Administration of bronchodilator – Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device $18
Inhaler Techniques
The following code is appropriate for inhaler techniques and can include demonstration of flow-operated inhaled devices such as flutter valves. The code may only be used once per day. This cannot be billed at the same time/ same visit as 94640. These can be billed on the same day, but must be a separate patient visit.
* 94664 – Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device can be used demonstrating (teaching) patients to use an aerosol generating device property.
Inhalation Treatment for Acute Airway Obstruction
When providing inhalation treatment for acute airway obstruction, Medicare will not pay for both 94640 and 94644 or 94645 if they are billed on the same day for the same patient. The coder must decide which of the two codes to submit for payment. Generally, it would be the code that has the greatest volume/quantity. The following information applies to inhalation treatments administered to Part B patients. This includes Emergency Room patients who are not admitted to the hospital. CPT code 94640 should only be reported once during a single patient encounter regardless of the number of separate inhalation treatments that are administered at that time. However, if there are multiple separate patient encounters for inhalation therapy on the same date of service, the additional encounters for inhalation therapy may be reported with modifier 76. Medicare defines a hospital outpatient encounter as “a direct personal contact between a patient and a physician, or other person who is authorized by State licensure law and, if applicable, by hospital or CAH staff bylaws, to order or furnish hospital services for diagnosis or treatment of the patient.”
* 94640 – Pressurized or non-pressurized 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 more than 1 inhalation treatment performed on the same date (separate single encounter), append modifier 76) (Do not report 94640 in conjunction with 94060, 94070 or 94400)
* 94644 – Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (For services of less than 1 hour, use 94640)
* 94645 – each additional hour (List separately in addition to code for primary procedure) (Use 94645 in conjunction with 94644)
Several commenters expressed concern about our proposal to reject the Panel’s recommendation that we designate HCPCS 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), as a non-surgical extended duration therapeutic service (extended duration service).
Extended duration services require an initial period of direct supervision, but the patient may be transitioned to general supervision once he or she is stable at the discretion of the supervising practitioner. One commenter believed that the physician’s presence should not be required for HCPCS code 94640 in the hospital, since this service can be performed by a patient at home.
Others commented that since the Panel’s charter does not prohibit the Panel from recommending extended duration services, it should be permitted to do so.
In the CY 2012 final rule, we indicated that the Panel may recommend only general, direct or personal supervision. HCPCS code 94640 is not performed over an extended period of time, and hospital patients receiving this service may require the supervising practitioner’s presence depending on their condition. At a future Panel meeting the Panel may reevaluate the supervision level for this service. Therefore, we continue to require direct supervision for HCPCS code 94640.
- Respiratory therapy services performed in a nursing facility or office setting may be eligible for payment to a physician if one of the following conditions is met:
- The service is personally performed by the physician or qualified non-physician practitioner if provision of the service is within the scope of his license.
- The service is performed by ancillary personnel employed by the physician, under the direct personal supervision of the physician, and is furnished during a course of treatment in which the physician performs an initial service and subsequent service(s) which reflect his active participation in and management of the course of treatment.
- CPT code 31720 is payable only if it is personally performed by the physician (or qualified non-physician practitioner).
- Safe and effective.
- Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
- Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
- Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
- Furnished in a setting appropriate to the patient’s medical needs and condition.
- Ordered and furnished by qualified personnel.
- One that meets, but does not exceed, the patient’s medical need.
- At least as beneficial as an existing and available medically appropriate alternative.
Note:
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Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in policies published on the Web.
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31720©
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Clearance of airways
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94640©
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Airway inhalation treatment
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94664©
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Aerosol or vapor inhalations
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This adjudication rules defines billing rules and documentation requirements for reporting nebulizer treatment.
Procedure code 94640 (Pressurized or non-pressurized 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.
Procedure 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.
Medicare defines a hospital outpatient encounter as “a direct personal contact between a patient and a physician, or other person who is authorized by State licensure law and, if applicable, by hospital or CAH staff bylaws, to order or furnish hospital services for diagnosis or treatment of the patint.”
5 January 2016
(For more than 1 inhalation treatment performed on the same date (separate single encounter), append modifier 76) (Do not report 94640 in conjunction with 94060, 94070 or 94400)
* 94644 – Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (For services of less than 1 hour, use 94640)
* 94645 – each additional hour (List separately in addition to code for primary procedure) (Use 94645 in conjunction with 94644)
94644: Demonstration and/or evaluation of patient use of nebulizer, MDI
• 94644 (continuous inhalation treatment with aerosol medication for acute airway obstruction, first hour)
• 94664 (demonstration and/or evaluation of patient utilization of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing device) is reported with modifier 59.
• The services may be reported when performed as incident to the physician’s services (ie, physician is in the office and available to provide assistance or direction).
• The Medicare National Correct Coding Initiative (NCCI) edits pair code 94664 with code 94640 (inhalation treatment for acute airway obstruction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing device) but allows both services to be reported when they are clinically indicated and modifier 59 (distinct procedural service) is appended to code 94664.
ICD-9-CM Codes That Support Medical Necessity
011.50–011.56
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Tuberculous bronchiectasis
|
162.0–162.5
|
Malignant neoplasm of trachea, bronchus or lung
|
162.8–162.9
|
Malignant neoplasm of trachea, bronchus or lung
|
163.0–163.1
|
Malignant neoplasm of pleura
|
163.8–163.9
|
Malignant neoplasm of pleura
|
197.0
|
Secondary malignant neoplasm, lung
|
197.2 –197.3
|
Secondary malignant neoplasm of respiratory system
|
276.7*
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Hyperpotassemia
Note: Use this code with a diagnosis of hyperkalemia.
|
277.00–277.03
|
Cystic fibrosis
|
277.09
|
Cystic fibrosis, with other manifestations
|
327.00–327.02
|
Organic disorders of initiating and maintaining sleep [Organic insomonia]
|
327.09
|
Other organic insomnia
|
327.10–327.15
|
Organic disorders of excessive somnolence [Organic hypersomnia]
|
327.19
|
Other organic hypersomnia
|
327.20–327.27
|
Organic sleep apnea
|
327.29
|
Other organic sleep apnea
|
327.30–327.37
|
Circadian rhythum sleep disorder
|
327.39
|
Other circadian rhythum sleep disorder
|
327.40–327.44
|
Organic parasomnia
|
327.49
|
Other organic parasomnia
|
327.51–327.53
|
Organic sleep related movement disorders
|
327.59
|
Other organic sleep related movement disorders
|
327.8
|
Other organic sleep related disorders
|
398.91
|
Rheumatic heart failure (congestive)
|
402.01
|
Malignant hypertensive heart disease with heart failure
|
415.12
|
Septic pulmonary embolism
|
415.19
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Other pulmonary embolism and infarction
|
416.2
|
Chronic pulmonary embolism
|
416.8-416.9
|
Chronic pulmonary heart disease
|
428.0
|
Congestive heart failure
|
464.10–464.11
|
Acute tracheitis
|
464.20–464.21
|
Acute laryngotracheitis
|
464.30–464.31
|
Acute epiglottitis
|
466.0
|
Acute bronchitis
|
466.11
|
Acute bronchiolitis due to Respiratory Syncytial Virus (RSV)
|
466.19
|
Acute bronchiolitis due to other infectious organisms
|
480.0-480.3
|
Viral pneumonia
|
480.8-480.9
|
Viral pneumonia
|
481
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Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia]
|
482.0–482.2
|
Other bacterial pneumonia
|
482.30–482.32
|
Pneumonia due to streptococcus
|
482.39
|
Pneumonia due to other streptococcus
|
482.40–482.42
|
Pneumonia due to staphylococcus
|
482.49
|
Pneumonia due to other staphylococcus
|
482.81–482.84
|
Pneumonia due to other specified bacteria
|
482.89
|
Pneumonia due to other specified bacteria
|
482.9
|
Bacterial pneumonia unspecified
|
483.0–483.1
|
Pneumonia due to other specified organism
|
483.8
|
Pneumonia due to other specified organism
|
484.1
|
Pneumonia in cytomegalic inclusion disease
|
484.3
|
Pneumonia in whooping cough
|
484.5–484.8
|
Pneumonia in other infectious diseases classified elsewhere
|
485
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Bronchopneumonia, organism unspecified
|
486
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Pneumonia, organism unspecified
|
487.0
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Influenza with pneumonia
|
491.0–491.1
|
Chronic bronchitis
|
491.20–491.22
|
Obstructive chronic bronchitis
|
491.8–491.9
|
Chronic bronchitis
|
492.0
|
Emphysematous bleb
|
492.8
|
Other emphysema
|
493.00–493.02
|
Extrinsic asthma
|
493.10–493.12
|
Intrinsic asthma
|
493.20–493.22
|
Chronic obstructive asthma
|
493.81–493.82
|
Other forms of asthma
|
493.90–493.92
|
Asthma, unspecified
|
494.0–494.1
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Bronchiectasis
|
495.0–495.9
|
Extrinsic allergic alveolitis
|
496
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Chronic airway obstruction, not elsewhere classified
|
500-505
|
Pneumoconioses and other lung diseases due to external agents
|
506.0–506.4
|
Respiratory conditions due to chemical fumes and vapors
|
506.9
|
Unspecified respiratory conditions due to fumes and vapors
|
507.0–507.1
|
Pneumonitis due to solids and liquids
|
507.8
|
Pneumonitis due to other solids and liquids
|
508.1
|
Chronic and other pulmonary
|
511.81
|
Malignant pleural effusion
|
511.89
|
Other specified forms of effusion, except tuberculous
|
511.9
|
Unspecified pleural effusion
|
513.0–513.1
|
Abscess of lung and mediastinum
|
514
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Pulmonary congestion and hypostasis
|
515
|
Post-inflammatory pulmonary fibrosis
|
516.0–516.3
|
Other alveolar and parietoalveolar pneumonopathy
|
516.8–516.9
|
Other alveolar and parietoalveolar pneumonopathy
|
517.1-517.8
|
|
518.0-518.7
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Other diseases of lung
|
518.81–518.84
|
Other pulmonary insufficiency, not elsewhere classified
|
518.89*
|
Other diseases of lung, not elsewhere classified
|
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*Note: Use this code for patients who have become oxygen dependent following an illness.
|
519.11
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Acute bronchospasm
|
519.19
|
Other diseases of trachea and bronchus
|
714.81
|
Rheumatoid lung
|
748.61
|
Congenital bronchiectasis
|
780.09
|
Other alteration of consciousness
|
780.51
|
Insomnia with sleep apnea
|
780.53
|
Hypersomnia with sleep apnea
|
780.57
|
Other and unspecified sleep apnea
|
780.97
|
Altered mental status
|
782.5
|
Cyanosis
|
786.01–786.07
|
Dyspnea and respiratory abnormalities
|
786.09
|
Other dyspnea and respiratory abnormality
|
786.1–786.2
|
Dyspnea and respiratory abnormalities
|
786.4
|
Abnormal sputum
|
786.7
|
Abnormal chest sounds
|
799.01-799.02
|
Other ill-defined and unknown causes of morbidity and mortality, asphyxia (hypoxemia)
|
995.0
|
Other anaphylactic shock
|
V10.11-V10.12
|
Personal history of malignant neoplasm, trachea, bronchus, lung
|
* Note: 518.89 – Use this code for patients who have become oxygen dependent following an illness.
- Physician’s orders.
- Plan of treatment.
- The patient’s response to treatment.
- An ongoing assessment for the patient’s continued need for treatment.
- In case of consecutive days of care, the medical record should indicate why the patient was not transferred to a higher level of care.
- Documentation of frequency must be consistent with the patient plan of care.