Are You Capturing Nebulizer Education Codes?

October 8th, 2010


We admit it.  We're on a quest. 

We want to help you increase your reimbursement by capturing all the dollars you are entitled to but leave on the table.

Earlier this week, I saw a nurse teaching a patient how to use a nebulizer.  And yes, nebulizer education is a billable code. It does not need to be done by the provider, but must be done subject to a provider's orders.  This particular office had never billed for nebulizer education.

The CPT Code is 94664:  Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device.

When may you bill the code? 

94664 requires that education be given seperate from a nebulizer treatment. There must be a signed, written order in the chart for the education which documents medical necessity.  For example, a House episode showed a clinic patient using the inhaler as if it were perfume.  Dr. House could have easily written an order explaining the medical necessity of education.

Other more common reasons could be training for new nebulizer user or for a prescription for a new type of device.

If a medically necessary E/M service is provided on the same day as the nebulizer education, append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the office visit code (99201-99215).

Also beware that CCI edits bundle 94664 into inhalation treatment 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). However you may use modifier 59 to override the edit if the treatment and education are two SEPERATE events.How about reimbursement? 

The national Medicare Allowed on the procedure is $14.38. Considering Medicare allows $14.01 for the nebulizer treatment itself, if the practice demostrates the use of the nebulizer with the treatment, billing for education instead results in better reimbursement.  Of course, materials codes should also be included.

If nebulizer education is part of your routine practice, be sure to capture this frequently overlooked code.



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