# nebulizer reimbursement (94640)



## jsa1517 (Sep 1, 2009)

Hello all!

Here in my office we give nebulizer treatments 94640. We give this with the medication albuteral J7613 most often, and we sometimes also give the treatment with atrovent J7644 in addition to the albuteral. But we are not really getting reimbursed for the nebulizer treatments if anything at all, we have been getting a lot of denials. 

Does anyone have any ideas, secrets, tricks etc on how we can improve are billing of this or what we can do different or in addition to to get reimbursement? 

If anyone can get back to me soon!

Thank You-
Jackie


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## encomma-watson (Sep 13, 2009)

*Neb treatments*

Hey Jackie,

We are not getting paid for the medication Albuteral.  Medicaid and Medicare states that they will reimburse for another medication that is used for nebulizer. It is generic medication for Albuteral.


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## LOVE2CODE (Sep 14, 2009)

jsa1517 said:


> Hello all!
> 
> Here in my office we give nebulizer treatments 94640. We give this with the medication albuteral J7613 most often, and we sometimes also give the treatment with atrovent J7644 in addition to the albuteral. But we are not really getting reimbursed for the nebulizer treatments if anything at all, we have been getting a lot of denials.
> 
> ...





Make sure you are using a 25 modifier on your e/m showing that other services were done. We are in a peds office and we get paid for the treatment and med.


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## jsa1517 (Sep 15, 2009)

thanks for your replies.. encomma-watson, do you know what that generic medication for Albuteral is? Do you use this generic in your facility? 

Get back to me when you can! Thank You-


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## jsa1517 (Sep 15, 2009)

oh yea, we most definitely use modifier 25, we are sure about that! We love modifiers hehe. Thanks, if you get any other information or find anything else out about other reimbursement for the nebulizer, I would love for you to share it!

Thank You-


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## coder_girl (Oct 15, 2009)

albeuterol is generic.  atrovent is ipatropium bromide.  I bill those and still cannot get paid for the medication.  I use the modifier 25 as well.  We get paid for the nebulizer but not the medication.  I don't know what to do about that.  Anyone have a specific J code that they have gotten paid?


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## kbarron (Oct 16, 2009)

Does anyone use the NDC # for the medication?


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## coder_girl (Oct 16, 2009)

I always use the ndc codes. BCBS of texas told us that it would be a requirement.


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## encomma-watson (Oct 25, 2009)

*Reimbursement*

How we bill is with both the 25 and 59 modifiers, the albuteral J code (which medicaid of NC will not reimburse).  Medicaid stated to me that we have to use the generic of Albuteral which is Atrovent - which is costly to our office (I think) or Duoneb.


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## jsa1517 (Oct 26, 2009)

encomma-watson said:


> How we bill is with both the 25 and 59 modifiers, the albuteral J code (which medicaid of NC will not reimburse).  Medicaid stated to me that we have to use the generic of Albuteral which is Atrovent - which is costly to our office (I think) or Duoneb.


just to make sure I understand what you are saying encomma-watson.. so you use both the 25 & 59 modifiers.. you put the -25 to the office visit obvioulsy and -59 to the medication or -59 to the nebulizer.. We put the -59 to the nebulizer & do get paid, we just can't get the darn medication paid.. 

Do you get any reimbursement when the atrovent J code is billed with the neb vs albuteral J code billed with neb? even though as you mentioned atrovent is the generic for albuteral? I am just curious because our Doctors give neb treatments often.


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## encomma-watson (Oct 26, 2009)

*nebulizer*

I use 25 mod for the e & M code and 59 on 96040 .  You can call me tomorrow at 336-358-1528 and they will give you the number that I will be at in the morning.


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## clmoreland (Oct 27, 2009)

*Nebulizer*

When you code the nebs, do you look up the LCD to make sure the diagnosis you used is covered?  Some will not pay if it is not an acute bronchitis, if the doctor diagnosis bronchitis, 490, look at the documentation, did the patient have abnormal breath sounds or bronchospasms diagnosed?  If so, that code can be used to get the treatment paid.  That is what we have found with ours, along with use of the 25 modifier.


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## jsa1517 (Oct 27, 2009)

yes, we have a cheat sheet with what codes are covered for the nebs. These darn insurances hehe


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## Blaw2743 (Aug 6, 2014)

Just to keep the threads consistent, I wanted to add to this poll.. Does anyone know if neb supplies, like A7003: Admin set should be assigned in addition to the neb treatment (94640) or does the code include the cost of the supply?

Thank you!


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## jflorezc (Jun 10, 2016)

the medication is inclusive in the treatment.
some providers have an agreement with the pharmaceutical provider about the medication at lower cost when they use it.
try to get your office manager to work on it with the pharmaceutical provider


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