Health Information Management

Q&A: Should we add a modifier for bronchodilation services?

APCs Insider, February 14, 2014

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Q: Our respiratory department performs a test where they have patients perform a spirometer test, give them a bronchodilator, and perform the spirometry again. They have been charging CPT® codes 94060 (bronchodilation responsiveness, spirometry as in 94010, pre- and post- bronchodilator administration) and 94640 (pressurized or non-pressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes) to report the test and the administration of the bronchodilator. However, we are hitting an edit and they want us to put a modifier on to get credit for the services provided. Is this correct?
 
A: You are receiving the edit because 94060 includes the administration of the bronchodilator. The parenthetical notes below this code state that the bronchodilator supply/medication can be reported separately. To append a modifier to 94640 means that the inhalation treatment is separate and distinct from the performance of the bronchodilation responsiveness test. In the situation you describe, this is not the case.
The National Correct Coding Manual notes in Chapter 11:
7. CPT code 94060 (bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) describes a diagnostic test that is utilized to assess patient symptoms that might be related to reversible airway obstruction. It does not describe treatment of acute airway obstruction. CPT code 94060 includes the administration of a bronchodilator. It is a misuse of CPT code 94640 (pressurized or non-pressurized inhalation treatment for acute airway obstruction…) to report 94640 for the administration of the bronchodilator included in CPT code 94060. The bronchodilator medication may be reported separately.
 
Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman, CEO, and founder of Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.



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