Pulmonology Coding Challenge: Why Are My 94664 Claims Getting Denied?

January 21, 2010

Before coding 94664, check off these items.

Question: Under the direction of my pulmonologist I recently submitted 94664 for reimbursement for training time, but the bill was rejected? Can I challenge this?

Answer: You can challenge training denials, provided your documentation supports the education’s reason. However, “not all payers will pay for 94664,” notes Gary N. Gross, MD, executive vice president of the Joint Council of Allergy, Asthma & Immunology.

If practices abuse the code, probably fewer payers will pay the approximately $14 national rate.

Solution: To support reporting 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device), documentation should include an indication of medical necessity, Gross stresses.

The physician should state in the chart’s plan or treatment portion two items: that the patient requires a teaching session on the use of his MDI, discus, nebulizer, etc., and why the session is needed. A statement could read, “The patient did not demonstrate the proper use of his MDI.”

© Supercoder.com

Available on CD: 2010 Update for pulmonology coders. With Jill Young.

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