ED Coding and Reimbursement Alert

Question: While working in our urgent care center, our nurse practitioner (NP) administered a nebulizer treatment recently, and I am unsure how to code for the supply. Notes indicate the drug was an inhalation solution made of albuterol and ipratropium bromide. Which J code represents this treatment?

Arkansas Subscriber

Answer: The albuterol/ipratropium bromide combination is also called DuoNeb Inhalation Solution. The most accurate J code for this treatment is J7620 (Albuterol, up to 2.5 mg, and ipratropium bromide, up to 0.5 mg, FDA-approved final product, noncompounded, administered through DME).

Code J7620 describes one dose of the treatment, so be sure to code for each inhalation treatment on your claim. Remember to always confirm the substance administered before selecting the final drug code. Documentation of the treatment should include the type and amount of medication required.

Also, be sure to report 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]) for the nebulizer treatment.

Note: Medicare will not pay for combination medications compounded by a pharmacy, but will pay if the pharmaceutical company compounds the medications.