How To Use CPT Code 94640

CPT 94640 describes the administration of pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 94640?

CPT 94640 can be used to describe the administration of oxygen under pressure or not under pressure to open obstructed air passages. This procedure is performed using devices such as an aerosol generator, nebulizer, metered dose inhaler, or intermittent positive pressure breathing (IPPB) device. It is used to treat patients with acute airway obstruction, allowing them to take in sufficient air. CPT 94640 can also be used for sputum induction for diagnostic purposes, where the provider uses the same devices to induce sputum for laboratory analysis.

2. Official Description

The official description of CPT code 94640 is: ‘Pressurized or nonpressurized 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.’

3. Procedure

1. The provider discusses the procedure with the patient or their guardian, explaining what will occur and, if the procedure is for diagnostic purposes, how the results will be interpreted.
2. The provider or nonphysician practitioner (NPP) administers the inhalation treatment using devices such as an aerosol generator, nebulizer, metered dose inhaler, or intermittent positive pressure ventilation (IPPV).
3. If necessary, the provider may administer an inhaled bronchodilator or use a nebulizer in conjunction with intermittent positive pressure ventilation (IPPV) to improve the patient’s breathing.
4. The provider may also use an aerosol generator, nebulizer, or metered dose inhaler containing an aerosolized bronchodilator to help relax the muscles surrounding the airways and open them up.
5. If spirometry is performed before or after the inhalation therapy, it is included with the procedure and should not be reported separately.
6. If the procedure is for sputum induction, the provider uses the same devices to induce sputum production for laboratory analysis.
7. The provider reviews and interprets the results of the sputum analysis and discusses the next steps with the patient or their guardian.

4. Qualifying circumstances

CPT 94640 is performed on patients with acute airway obstruction or for sputum induction for diagnostic purposes. It is commonly used to treat conditions such as asthma, bronchitis, chronic obstructive pulmonary disease (COPD), and emphysema. The procedure can be performed by a provider or a nonphysician practitioner (NPP) under the supervision of a provider. The use of devices such as an aerosol generator, nebulizer, metered dose inhaler, or intermittent positive pressure breathing (IPPB) device is essential for the administration of the inhalation treatment.

5. When to use CPT code 94640

CPT code 94640 should be used when the provider administers pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes. It is appropriate to use this code when the procedure is performed using devices such as an aerosol generator, nebulizer, metered dose inhaler, or intermittent positive pressure breathing (IPPB) device. However, it should not be reported in conjunction with CPT codes 94060 or 94070.

6. Documentation requirements

To support a claim for CPT 94640, the provider must document the following information:

• Patient’s condition and the need for inhalation treatment
• Devices used for the treatment, such as an aerosol generator, nebulizer, metered dose inhaler, or intermittent positive pressure breathing (IPPB) device
• Date and duration of the procedure
• Results of any spirometry performed
• For sputum induction, the provider should document the purpose of the induction, the method used, and the results of the sputum analysis
• Signature of the provider or nonphysician practitioner (NPP) performing the procedure

7. Billing guidelines

When billing for CPT 94640, ensure that the procedure is performed by a qualified provider or nonphysician practitioner (NPP) using the appropriate devices. It should not be reported in conjunction with CPT codes 94060 or 94070. If multiple inhalation treatments are performed on the same date, append modifier 76 to indicate a repeat procedure by the same provider. Medicare and some private payers may not recognize modifier 76, so it is important to check with the specific payer before submitting the claim.

8. Historical information

CPT 94640 was added to the Current Procedural Terminology system on January 1, 1990. There have been several changes to the code over the years, including updates to the official description and the addition of modifier 76 for repeat procedures.

9. Examples

1. A patient with asthma receives pressurized inhalation treatment using a nebulizer to relieve acute airway obstruction.