Get a Grip on Your Nebulizer Supply Coding

Or risk losing hundreds in reimbursement

You may not want to bother billing nebulizer supply codes, but the pennies add up. Although the codes for nebulizer drugs (J7618-J7619, J7644) and medical supplies (A7003, A7005, A7015) pay about $1 each, you should take the time to bill for these extra items, if the payer permits it.
 
Allergists often underuse the HCPCS Level II codes. But the alphanumerical national codes, which Medicare, Medicaid and most private payers require, allow physicians to capture reimbursement for office supplies.
 
The different systems leave coders wondering whether carriers really reimburse for supply codes billed with nebulizer treatments. Most insurers pay for J7619 (Albuterol, all formulations including separated isomers, inhalation solution administered through DME, unit dose, per 1 mg [Albuterol] or per 0.5 mg [Levalbuterol]), says Valerie Frederick, president/owner of Physicians Services, a medical billing service in Cumming, Ga. "Carriers pay a very low amount (approximately 10 percent of our charge)." But Frederick admits, "A little is better than nothing." At least the reimbursement covers the cost.
 
So, now that you're convinced that you should bill for pennies, how do you do it? (For a complete list of applicable codes and reimbursement, see "Clip-n-Save: Nebulizer Supplies Charts.")
Report Drug With a J Code
You should bill for the medication used in the inhaler with the appropriate HCPCS J code, coding experts say.
 
Common nebulizer drugs include various forms of albuterol (Ventolin, Proventil) and levalbuterol (Xopenex). Select the supply code based on the medication's form. For concentrated forms, assign J7618 (Albuterol, all formulations including separated isomers, inhalation solution administered through DME, concentrated form, per 1 mg [albuterol] or per 0.5 mg [levalbuterol]), says Angela L. Mohun, CPC, a coder/trainer for Physicians Associates, an 80-physician group practice in Central Florida. For premixed or unit-dose forms, report J7619. "Depending on how many treatments the physician provides, bill the J codes in units as well," Mohun says. For J7618 and J7619, you should bill 1 unit per 1 mg of albuterol and 2 units per 1 mg of levalbuterol.
 
For instance, an allergist administers two inhalation treatments (94640, Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]) containing concentrated albuterol. Report J7618 x 2, one unit per 1-mg concentrated dose. If the allergist used the unit-dose form of albuterol, you should bill J7619 x 2.
 
When the doctor uses a concentrated inhalation drug, you should bill separately for the saline solution used to dilute it (A7019, Saline solution, per 10 ml, metered dose dispenser, for use with inhalation drugs; J7051, Sterile saline or water, up to 5 cc), says Jeremy D. Nelson, marketing [...]

- Published on 2003-09-15