How to Code Nebulizer Treatments
Nebulizer treatments in the office can be a significant cost of time and money for primary care physicians. They require expensive equipment, trained staff and time-consuming counseling and follow-up care. Each visit requires the appropriate ICD-9, or International Statistical Classification of Diseases and Related Health Problems, codes. This is the most widely used coding system in the world. ICD-9 codes are created by the World Health Organization to better classify the clinical picture of every patient visit. Coding correctly for nebulizer treatments will identify those patients who require more time in the office and a higher level of care.
Instructions
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Begin inhalation nebulizer treatment in the office and have a trained assistant monitor the patient's status closely. Code this as 94640 (pressurized or non-pressured inhalation treatment for acute airway obstruction or for sputum induction).
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Re-evaluate the patient for a clear response to the inhalation treatment, and if there is no improvement, administer a second treatment. Some physicians check a pre- and post-test oxygen level or use a machine called a spirometer to measure the flow of air in the lungs. Coding for these will not receive any reimbursement. If a second treatment is required, document this and the time required to complete all treatments. Code this as 94664-76 for each subsequent treatment.
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Counsel the patient after the treatment and code it as 94664-59. Document whether the patient has been using his medication correctly and demonstrate the proper technique. Take note of the time from beginning to end and document time spent face-to-face with the physician.
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Diagnose the patient's disease status using the appropriate hierarchical condition code. Review the chest X-rays for evidence of emphysema and code this as 493. Look at the pulmonary function tests. If there is asthma and the patient is having wheezing, code 492.02. Patients unresponsive to treatment have status asthmaticus and require code 493.0.
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Tips & Warnings
Don't forget to code J7613 if the patient has a point-of-service plan or preferred provider organization insurance. This will help reimburse the cost of the albuterol medication the nebulizer delivers.
Don't make the common mistake of coding for both 492.01 and 492.02. While clearly a patient with status asthmaticus is having an acute exacerbation, coding for both will down-code the encounter to a lesser severity.
References
Resources
- Photo Credit oxygen mask and nebuliser image by alma_sacra from Fotolia.com
