If a patient leaves the facility, then returns one the same date for additional inhalation therapy treatment, are we able to bill for the second episode of care?


Per the CPT® manual and the NCCI Policy Manual, if a patient leaves the facility and comes back on the same date of service for additional treatment, this second episode of care may be reported with modifier 76 appended to CPT code 94640. However, the current MUE value for code 94640 is listed as 1 (meaning the maximum number of units of service allowed by the same provider for the same beneficiary on the same date of service is 1), which contradicts the language in both the CPT manual and the NCCI Policy Manual. Units of service reported in excess of the MUE value will be denied.

This question was answered in our Coding Essentials for RT/Pulmonary Function. For more hot topics relating to respiratory services, please visit our store or call us at 1.800.252.1578, ext. 2.


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