Corporate Compliance

Nebulizer treatment billing

Compliance Monitor, April 22, 2005

Q: If our ED nursing staff performs nebulizer treatments, may they be billed separately, or do the treatments have to be performed by a respiratory therapist? We do not have nebulizer treatments built into our ED leveling system.

A: If your state defines respiratory treatments as within the scope of nursing services, they are separately billable provided you meet the three main requirements for any separately billable service:

1. Services must be ordered by a treating physician/practitioner;

2. Services must be medically necessary, as documented by presenting signs or symptoms or diagnoses provided by treating physician/practitioner; and

3. The procedure must be properly documented (e.g., time of treatment, type of treatment, dosage, etc.).

When these requirements are met, nurse-performed procedures are separately billable. Code nebulizer treatments with CPT 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).

This question was answered by Valerie Rinkle, MPA, revenue cycle director for Asante Health System in Medford, OR.

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