Here's a scenario: During an outpatient visit, an asthmatic patient is wheezing and having difficulty breathing, which requires one or more bronchodilator treatments for intervention: 493.01, 493.02, 493.21 or 493.22. The patient did not use his MDI devide, nebulizer and the like properly prior to the visit; as such he was given an education about the use if these devices post the treatment.
Report it: At the outset, report 94640 apart from the proper evaluation & management code with a modifier, unless the payer calls for modifier 25 with the evaluation & management. After this code 94664 with modifier 59 (Distinct procedural service) as the patient needed additional instruction for his daily maintenance medication.
This is contrary to the medication provided for immediate intervention – 94640.
To put it in a nutshell, if the patient required separate education post getting an inhalation treatment on the same day, you'd bill both services – treatment as well as education – adding modifier 59 to 94664.
Reasoning: The CCI places a level-one edit on 94640 and 94664.As such Medicare and payers that follow CCI edits may need modifier 59 on the component code (94664) to show that the teaching is a distinct procedural service from the inhalation treatment. It's key that the teaching was not part of the treatment for the patient, which would be one parallel encounter. It's key that the teaching wasn't part of the treatment for the patient, which would be one parallel encounter – teaching while treating. Remember in the example, the teaching took place separately after the patient got the treatment. You should break these services into two separate serial encounters, one after another.
Easy dollars
If payers wouldn't pay your 94664 claim, you'd require to support it with documentation indicating medical necessity to reimburse the approximately $16 national rate (0.47 relative value units multiplied by 2011 conversion factor of 33.9764). For example, you may need to state in the Plan of Treatment portion of the written record that the patient needs an educational session on the use of his MDI, diskus, nebulizer, etc. Apart from this, do not forget to note why the session is called for.
Report it: At the outset, report 94640 apart from the proper evaluation & management code with a modifier, unless the payer calls for modifier 25 with the evaluation & management. After this code 94664 with modifier 59 (Distinct procedural service) as the patient needed additional instruction for his daily maintenance medication.
This is contrary to the medication provided for immediate intervention – 94640.
To put it in a nutshell, if the patient required separate education post getting an inhalation treatment on the same day, you'd bill both services – treatment as well as education – adding modifier 59 to 94664.
Reasoning: The CCI places a level-one edit on 94640 and 94664.As such Medicare and payers that follow CCI edits may need modifier 59 on the component code (94664) to show that the teaching is a distinct procedural service from the inhalation treatment. It's key that the teaching was not part of the treatment for the patient, which would be one parallel encounter. It's key that the teaching wasn't part of the treatment for the patient, which would be one parallel encounter – teaching while treating. Remember in the example, the teaching took place separately after the patient got the treatment. You should break these services into two separate serial encounters, one after another.
Easy dollars
If payers wouldn't pay your 94664 claim, you'd require to support it with documentation indicating medical necessity to reimburse the approximately $16 national rate (0.47 relative value units multiplied by 2011 conversion factor of 33.9764). For example, you may need to state in the Plan of Treatment portion of the written record that the patient needs an educational session on the use of his MDI, diskus, nebulizer, etc. Apart from this, do not forget to note why the session is called for.
