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Code 94640 to cover the comprehensive service the physician provided. An established patient with emphysema presents complaining of shortness of breath. The doctor provides inhalation treatment, trains the patient on using the nebulizer at home, and provides an expanded problem-focused examination and medical decision-making of low complexity. Considering this, which CPT code should you report here? Well, one CPT code will not suffice. You will need more than CPT code for this encounter. You should use 94640 to cover the comprehensive service the physician provided. Since the physician also carried out an office visit, go for 99213 based on your documentation of an expanded problem-focused exam with low-complexity decision-making. You might be required to add modifier 25 to 99213 to indicate that the evaluation & management service was significant and separately identifiable from 94640. You should use 94640 in place of 94664 since the physician's primary intent was to treat the obstruction. Word of caution: If you bill 94664 along with 94640 on the same day to Medicare, see to it that you justify that the physician provided the 94664 service distinctly separate from the treatment. In this instance, add modifier 59 to 94664 to notify the payer that the family physician performed 94664 separate from 94640. The documentation should cover details on the medical necessity for separately providing this service. Here's an instance: The physician determined that the patient's plan of care should cover inhalation therapy, or the patient is new to this therapy and doesn't know the administration techniques involved in the procedure. The note should clearly make out that the physician demonstrated the inhaler to the patient separate from the administration for treatment. Or else, the insurer may think you're trying to report a service twice. Here's a tip that'll stand you in good stead: Even though technically not called for it may help to link separate diagnosis codes to the E/M and the nebulizer treatment. For example, you could link 786.05 to 99213, and link the emphysema code to 94640. For further details on this and for other specialty-specific articles to assist your family practice coding, sign up for a good medical coding resource like Coding Institute.
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