Inhalation treatment

We recently received payment denial for CPT code 94640 (inhalation therapy for therapeutic or diagnostic purposes). We submitted this code with an office visit level 3, the required 25 modifier and a diagnosis code of bronchospasm. The insurer claims that code 94640 with location 11 (office) will be denied now as falling under respiratory therapy which falls under PT, OT and speech therapy due to 2014 Medicare guidelines. Does anyone know if this is a legitimate denial and the rationale. Performing this service in the office may avoid an emergency room visit and is certainly cost effective.

I would be interested in anyone else’s experience with payment denial for this service. Thank you.

Richard. J. Fairley, M.D., M.P.H.
Director, Clinical Compliance and Quality Assurance
Grand River Medical Group (formerly Dubuque Internal Medicine)
1515 Delhi Street, Suite #100
Dubuque, IA 52001
563-557-9111

Comments

  • Oh yes they are doing this now! It’s ridiculous we even have United Mediare Advantage denying the drugs under the DME LCD stating they are not medically necessary. Hello, the patient is receiving a treatment in Urgent Care- this is not a home DME device for which they are putting in a solution. Appeal it

    Karyn Cardenas-Foray, CPC, CPMA ,CHCA, CEMC,CIMC,CSEMC
    AHIMA ICD10 PROFICIENT
    Government Reimbursement Analyst-Sharp Health Care
    PFS-CCD 3rd Floor
    858-499-4382
  • Isn’t there a modifier that states the doctor is ok to do PT?

    " A bad day is only as bad as you let it be; smile and show the world your better side, and the world just may smile back with you."
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