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Question: A pulmonologist performed a nebulizer treatment for a patient鈥檚 asthma and demonstrated how to use the equipment at the same time. We filed a claim with 94640 and 94664-59, but the claim was denied.

How can we correct the claim?

Washington Subscriber

Answer: From what you鈥檝e explained, you shouldn鈥檛 need to report both 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device) and 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device) with modifier 59 (Distinct procedural service) appended to 94664.

Code 94664 is considered bundled into 94640, and since the demonstration and treatment occurred at the same time, you shouldn鈥檛 unbundle the two services. According to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits, the 94640/94664 edit pair carries a modifier indicator of 鈥�1.鈥� This means that when 94640 is a column 1 code, 94664 can be unbundled with the correct modifier, if unbundling the services is appropriate.

For example, if the pulmonologist prescribed a new inhaler for home use, which required additional patient demonstration, you鈥檇 use a modifier to unbundle and report both distinct services.

Additionally, you should review your individual payer preferences to confirm if they want you to unbundle the services by appending 94664 with modifier 59 or one of the X{EPSU} modifiers, such as XU (Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service), if applicable.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC