emphysema claims aren’t being fully reimbursed?why

Want to know why your emphysema claims aren’t being fully reimbursed? Often, the reason is that you’re lacking two things when you submit your claim. You aren’t being detailed enough with your coding and your don’t have enough detailed medical documenation to back up your full diagnostic testing that is required to accurately diagnose emphysema and narrow the degree and type. When you’re compiling the medical billing for an established patient with active emphysema (492.8, Other emphysema) and they present and are complaining of shortness of breath (786.05); the physician provides inhalation treatment, trains the patient on using the nebulizer at home, and provides an expanded problem-focused examination and medical decision-making of low complexity, how would you report this?

There will be multiple codes for this visit as the emphysema was the reason for the visit however the physician also provided services and consulted regarding the nebulizer so there will need to be additional codings on the medical billing to take all the services rendered into consideration.

Be sure and capture 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered-dose inhaler or intermittent positive pressure breathing (IPPB) device]) to cover the comprehensive service the physician provided regarding using the nebulizer. Additionally, add in 99213, and back it up with documentation to show that the physician performed an exam of an existing problem with low- complexity decision-making.

If your documentation shows that the physicians’s primary intent was to treat the difficulty in breathing at the time of the visit, switch to 94640(Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device).

It’s important to always show if the emphysema is currently active at the time so further claims can use that diagnosis as part of the history where applicable.

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