Usually when the nurse or medical assistant spends time assisting a patient with how to use an inhaler, you need to keep in mind three critical points before coding: the type of device used, documentation requirements, and qualifying modifiers. Here are some additional pointers that you need to keep in mind while coding and billing for asthama:
- You must correctly categorize the Diskus. If a person learns to use an Advair Diskus or any other metered dose inhaler (MDI) from the nurse or medical assistant you should report 94664.
- You can include treatment in teaching session. If you administer a medication dose during the teaching session you need to keep in mind that both services are bundled into 94640.
- Modifier 59 can be used for Extra Education. After receiving an inhalation treatment on the same day if the patient required separate education, both the services need to be billed using modifier 59 with code 94664.
- It is essential to prove medical necessity. Your physician can garner $19 when reporting 94664, based on the national Medicare non-facility rate payment schedule. So you need to encourage physicians to document medical necessity for 94664 and help them achieve reimbursement.
- You also need to scrutinize your supply billing. For a nebulizer education session, if you supply the albuterol you can easily report the medication to your insurer.
- If you treat an asthma patient presents with severe wheezing or a recognizable asthma attack, you can report 493.02 which is an acute exacerbation code. Wheezing, status asthmaticus or exacerbated asthma must be reported by the physician in the documentation.
- But if the patient was not in distress in the scenario you described, you can undoubtedly assign a fifth-digit of 0 to the code. You need to report 493.00 which is a controlled extrinsic asthma visit and link the E/M code with it.
- For asthmatic patients, codes ranging from 98960-98962 can be used for services rendered by NPP. If it is provided by ENT then codes 99401-99412 can be used to report the services.