Home Health & Hospice Week

Use J7621 only for pre-manufactured combinations of albuterol and ipratropium.

Many changes have hit drug pricing in 2004, but one of the simplest could trip up your coding for inhalation drugs. New HCPCS code J7621 debuted Jan. 1 and indicates "Albuterol, all formulations, including separated isomers, up to 5 mg (albuterol) or 2.5 mg (levalbuterol), and ipratropium, up to 1 mg, compounded inhalation solution, administered through DME," according to a notice posted on the Web sites of durable medical equipment regional carriers Cigna, Palmetto GBA and AdminaStar Federal. An earlier DMERC notice implied that suppliers and pharmacies should use the new code to bill for albuterol-ipratropium combinations they compounded themselves, says Asela Cuervo with the American Association for Homecare. But the new coding notice, which warns of "a major revision to coding guidelines," makes it clear that suppliers should use the new code only for pre-manufactured combinations of the inhalant drugs, explains Jacki McClure, director of the National Respiratory Network and government relations for The MED Group in Pittsburgh, PA. "This code may only be used when these drugs are provided in combination by a manufacturer or repackager in a vial with a single NDC number," the DMERCs say. When compounding the drugs, suppliers should bill using separate J codes for the individual drugs, as usual, advises Mickey Letson with Letco Medical in Decatur, AL. And they shouldn't forget the accompanying modifiers - KP for the first drug in the compound and KQ for any subsequent drugs, Letson points out. "Despite the narrative description of the code, J7621 must not be used for compounded inhalation solutions of these drugs," the DMERCs warn. Instead, use J7619 for albuterol and J7644 for ipratropium. Food and Drug Administration and Medicare rules require separate coding of compounded drugs, these experts say. The new coding description is careful to point out that DuoNeb is only one example of the pre-manufactured combination of these drugs, McClure notes. J7621 can be used for any other combination that comes along from another manufacturer. Editor's Note: The coding notice is at www.cignamedicare.com/articles/jan04/cope479.html.