Medically Unlikely Edits (MUEs) for Pressurized or Non-pressurized Inhalation Treatment

Published 01/12/2018

Palmetto GBA has seen an increase in the number of MUE appeals for CPT code 94640. This code is for pressurized or non-pressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device.

We have noticed that providers are billing multiple units and the NCCI Manual, Chapter 11, Section J states that CPT code 94640 should only be reported once during a single patient encounter regardless of the number of separate inhalation treatments that are administered. If CPT code 94640 is used for treatment of acute airway obstruction, spirometry measurements before and/or after the treatment(s) should not be reported separately.

CPT 94640 should only be reported once during a single patient encounter regardless of the number of separate inhalation treatments that are administered. CMS considers the entire time a patient is in observation status or in the Emergency Room as a single encounter. Please share with your coding staff and ensure claims are correctly coded the first time you submit your claim. This eliminates the need for an appeal to be submitted.