How To Use CPT Code 94642

CPT 94642 describes the aerosol inhalation of pentamidine for the treatment or prevention of pneumocystis carinii pneumonia. 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 94642?

CPT 94642 is used to describe the administration of pentamidine through aerosol inhalation. This procedure is performed using a nebulizing device, which converts the medication into a fine mist that the patient breathes in. It is commonly used to treat or prevent pneumocystis carinii pneumonia (PCP), a type of pneumonia that is most common in patients with suppressed immune systems, such as those with HIV.

2. Official Description

The official description of CPT code 94642 is: ‘Aerosol inhalation of pentamidine for pneumocystis carinii pneumonia treatment or prophylaxis.’

3. Procedure

1. The healthcare provider prepares the nebulizer, which is a device that converts the pentamidine medication into a fine mist.
2. The provider carefully measures the prescribed dose of pentamidine for the patient.
3. The patient is fitted with a mask to ensure proper inhalation of the medication.
4. The patient breathes in the medication for a period of 30 to 45 minutes.

4. Qualifying circumstances

CPT 94642 is typically used for patients who require treatment or prophylaxis for pneumocystis carinii pneumonia. This condition is most commonly seen in patients with suppressed immune systems, such as those with HIV. The procedure should be performed by a qualified healthcare provider who is experienced in administering aerosol inhalation therapy.

5. When to use CPT code 94642

CPT code 94642 should be used when a patient requires aerosol inhalation of pentamidine for the treatment or prevention of pneumocystis carinii pneumonia. It is important to ensure that the patient meets the qualifying circumstances for this procedure and that it is medically necessary.

6. Documentation requirements

To support a claim for CPT code 94642, the healthcare provider must document the following information:

• Patient’s diagnosis of pneumocystis carinii pneumonia or the need for prophylaxis
• Specific dose of pentamidine administered
• Date and duration of the aerosol inhalation procedure
• Any relevant patient information, such as their medical history or current medications
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 94642, it is important to ensure that the procedure is performed by a qualified healthcare provider and that the documentation requirements are met. This code should not be reported with other codes unless specifically instructed to do so. It is important to follow the guidelines provided by the payer and to accurately report the services provided.

8. Historical information

CPT code 94642 was added to the Current Procedural Terminology system on January 1, 1991. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with HIV receiving aerosol inhalation of pentamidine to prevent pneumocystis carinii pneumonia.
2. A patient diagnosed with pneumocystis carinii pneumonia undergoing aerosol inhalation of pentamidine for treatment.
3. A healthcare provider administering aerosol inhalation of pentamidine to a patient with a suppressed immune system as prophylaxis for pneumocystis carinii pneumonia.
4. A patient with HIV receiving aerosol inhalation of pentamidine to prevent a recurrence of pneumocystis carinii pneumonia.
5. A healthcare provider performing aerosol inhalation of pentamidine for a patient with a history of pneumocystis carinii pneumonia as a preventive measure.
6. A patient with a suppressed immune system undergoing aerosol inhalation of pentamidine to treat pneumocystis carinii pneumonia.
7. A healthcare provider administering aerosol inhalation of pentamidine to a patient with HIV as prophylaxis for pneumocystis carinii pneumonia.
8. A patient diagnosed with pneumocystis carinii pneumonia receiving aerosol inhalation of pentamidine for treatment and symptom relief.
9. A healthcare provider performing aerosol inhalation of pentamidine for a patient with a history of pneumocystis carinii pneumonia to prevent a recurrence.
10. A patient with a suppressed immune system undergoing aerosol inhalation of pentamidine to prevent pneumocystis carinii pneumonia.