Question on Billing Sick Child Visit

Here's another question we received

I am the billing manager for a pediatric office. When we see a sick child for wheezing and/or tightness in the chest we usually bill 99213 for office visit and give them a inhalation breathing treatment under procedure code 94664 but we never get reimbursed for the treatment only the office visit. How do I get insurance companies to consider procedure 94664 am I billing this correctly?

Michele's answer

When you see the patient for the wheezing/tightness and you do the 94664, I would recommend trying a 25 modifier on the E&M code indicating that the E&M was a Significant, Separately Identifiable E&M Service by the Same Physician on
the Same Day of the Procedure or Other Service.

Also, if you have more than one diagnosis and if it is appropriate to use a different diagnosis for the E&M than you use for the 94664 that may help.
For example, if a child comes in with an upper respiratory infection, and you give him a breathing treatment for the wheezing/tightness, then you could bill the 99213 with dx URI and the 94664 with the wheezing/tightness diagnosis.

Hope that helps.