E&M 99213 + Pressurized inhalation (94640)
E&M and nebulizer treatment bundle without modifier 25 on the E&M.
Why this pair bundles
Pre-treatment assessment is included in 94640.
Modifier-bypass policy
Modifier indicator: 1 — modifier 59 / XE / XP / XS / XU permitted when supporting documentation is on file.
Modifier 25 on E&M when separate significant evaluation occurred.
Documentation requirements
- Distinct complaint or comprehensive assessment beyond the respiratory issue
Common clinical scenarios
- Asthma exacerbation eval + nebulizer treatment + concurrent BP medication management
Frequently asked questions
Why does CMS bundle 99213 and 94640?
Pre-treatment assessment is included in 94640.
When can I use modifier 59 (or X{EPSU}) to bypass?
Modifier 25 on E&M when separate significant evaluation occurred.
What documentation supports separate billing?
Distinct complaint or comprehensive assessment beyond the respiratory issue.
When does this conflict typically arise?
Asthma exacerbation eval + nebulizer treatment + concurrent BP medication management.
Related NCCI edits
- E&M 99213 + RPM treatment management (0780T equivalent)Remote physiologic monitoring services and same-day E&M generally do NOT bundle
- E&M 99213 + Joint injection 20610E&M and major joint injection (knee, shoulder, hip) bundle without modifier 25 o
- E&M 99213 + Venipuncture 36415Office E&M and routine venipuncture can be reported together — 36415 is separate
- E&M 99213 + Urine pregnancy test 81025Urine pregnancy test (POC) and office E&M can be reported together — 81025 is se
- E&M 99213 + Vaccine admin 90471E&M 99213 and vaccine administration 90471 bundle without modifier 25 on the E&M
- E&M 99213 + ECG 93000Office E&M and complete ECG can be reported together but require modifier 25 on
Sources
Catch NCCI 99213/94640 conflicts before submission
ApprovalHelp auto-flags NCCI bundling conflicts on the claim line before you submit. Modifier-bypass eligibility checked against current quarterly NCCI tables. no setup fee.
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