Respiratory Question for the Week of June 5, 2017

Question:

An outpatient lung cancer patient on a ventilator is receiving intermittent breathing nebulizer treatments (94640) and is also receiving Milrinone via continuous inhalation treatment with aerogen generator. The patient receives the continuous Milrinone 24 hrs/day x 5 days. The Milrinone runs for six hours and then is changed out with new pre-loaded syringe.

Is the continuous inhalation treatment; first hour 94644, billed on the first day of the five-day run, billed once per day for the 5 days, or billed each time the continuous treatment is changed out (every 6 hours)? The answer to the above question will then answer how to bill 94645 continuous inhalation treatment; each additional hour.

Answer:

We submitted your question to the American Medical Association (AMA), which said that, for an outpatient claim submitted with detailed code level line items per date of service (DOS), CPT code 94644 would be reported as the initial hour of inhalation therapy per DOS. The remaining therapy hours would be billed as supported in documentation for each additional continuous therapy hour for administration of inhaled Milrinone.

Consider, however, the limitations of the AMA’s guidelines as well as payer limitations of per DOS units that would be applicable to the outpatient encounter. Medicare would limit billing of 94644 to one unit per DOS and 94645 to 4 units per DOS. Additionally, the National Correct Coding Initiative procedure-to-procedure edits do not allow billing of 94640 in combination with 94644/94645.