The American Academy of Pediatrics Coding Hotline has recently received numerous questions about denials for office-based evaluation and management (E/M) services when reported with pulmonary service codes such as spirometry (94010) and nebulizer treatments (94640). Over the years, most practices received payment for these 2 distinct services without the use of any modifiers; however, we are finding that has changed. Some carriers, including United Healthcare, are now interpreting Current Procedural Terminology (CPT®) guidelines very literally. In the CPT guidelines under the “Other Services” heading in the “Pulmonary” section, it states, “Codes 94010–94799 include laboratory procedure(s) and interpretation of test results. If a separate identifiable Evaluation and Management [emphasis added] service is performed, the appropriate E/M service code should be reported in addition to 94010–94799.” Because the guidelines are written this way, certain carriers have determined that modifier 25 appended to the separate E/M...

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