Use code 94664 when teaching patients how to use a nebulizer or inhaler. The CPT® definition is:
Demonstration and/or evaluation of patient utlization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device. The service may only be reported once/day. It is not a code defined by time. Some payers may have frequency edits built into their systems to prevent payment of the instruction more than once in a time period.
It is an active code in the Medicare Fee Schedule. It has a PC/TC status indicator of 5, incident to. That means, a staff member may perform the service incident to a physician. Incident to is a Medicare concept. (Review the Codapedia article on incident to.) In short, the physician must order the service and be present in the suite of offices when the service is provided to a Medicare patient. The 2009 National Medicare Fee Schedule amount is just under $15.
When provided on the same day as an office visit, CPT® rules do not require a modifier. Some payer's claims editing systems, however, will require a 25 modifier on the E/M service performed on the same day.
Three common diagnosis codes used when submitting this service are 496, chronic airway obstruction, 466, acute bronchitis, and 493.90, asthma, unspecified.
###
Questions, comments?
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Your practice has utilized the same medical billing software for years. The medical billing staff says it is time for a change. You don't necessarily disagree, but you also don't know where to begin your search for new software. There are so many vendors offering so many products that making sense of it all can be challenging.
Each year CMS publishes an Advance Notice of the upcoming years Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies and asks for comments related to it. Each of the comments are carefully reviewed and responded to and often are impactful to changes seen between the Advance Notice and final publication referred to as the Rate Announcement. With health equity as a primary focus for 2023, CMS announced some policy changes that may impact your organization.
Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.
We’ve seen a number of OIG risk adjustment data validation (RADV) audits recently where the independent review contractor was simply looking for any codes the payer reported that were not supported by the documentation, in an effort to declare an overpayment was made and monies are due to be repaid. However, it was refreshing to read this RADV audit and discover that the independent review contractor actually identified HCCs the payer failed to report that, while still resulting in an overpayment, was able to reduce the overpayment by giving credit for these additional HCCs. What lessons are you learning from reading these RADV audit reports?
After events of mass violence, it’s easy to feel helpless, like there is little we can do. In fact, we can help individuals, families, and communities build resilience and connect with others to cope together. The SAMHSA-funded National Child Traumatic Stress Network has developed a range of resources to help children, families, educators, and communities including the following which you can access via links in this article.
HIPAA covers nearly every aspect of how medical and personal information is collected, utilized, shared, and stored within the healthcare industry. Title II of the rules is applied directly to medical billing companies and independent coders. The 'Big 2' rules that medical billing companies must adhere to revolve around privacy and security.
It appears that the end of the 1135 waivers related to the COVID-19 public health emergency (PHE) has begun. According to CMS, the residents of skilled nursing facilities, long-term care facilities, and inpatient hospice centers have struggled due to the effects of some of the 1135 waivers. CMS is focusing primarily on removing the 1135 blanket waivers that pertain to certain aspects of care, training, and maintenance of these facilities to ensure the weakest of our citizens are guaranteed adequate care.
