Internal Medicine Coding Alert

Published on Sat Jun 28, 2008 PDF

Your albuterol, levalbuterol pay hinges on returning to more specific J codes

Although you just got used to the most recent rules for reporting nebulizer treatment medications, payment depends on updating your codes -- again.

Your 2008 superbill should be fresh off the presses from its changes to albuterol/levalbuterol codes J7602 (Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, noncompounded, administered through DME, concentrated form, per 1 mg [albuterol] or per 0.5 mg [levalbuterol]) and J7603 (... unit dose ...).

But you'll now need to shift the supply codes back to the following:

• J7611 -- Albuterol, inhalation solution, FDA-approved final product, non- compounded, administered through DME, concentrated form, 1 mg

• J7612 -- Levalbuterol, inhalation solution, FDA-approved final product, non- compounded, administered through DME, concentrated form, 0.5 mg

• J7613 -- Albuterol, inhalation solution, FDA-approved final product, non- compounded, administered through DME, unit dose, 1 mg

• J7614 -- Levalbuterol, inhalation solution, FDA-approved final product, non- compounded, administered through DME, unit dose, 0.5 mg.

For instance, in March, "we were using J7603 for albuterol," says Diane Nelson, RTR, CPC, medical coder for Vanguard Medical Services in Frederick, Md. In April, "we changed back to J7613." The CMS fee schedule Web site recognizes that codes J7611-J7614 and J7602-J7603 are not on the fee schedule at all.

Switch Back to Drug-Specific Codes

You may recall that you previously removed J7611-J7614 from your encounter sheet. HCPCS 2007 added these codes and swept them away just six months later. CMS deleted J7611-J7614, effective July 1, 2007, says Denae M. Merrill, CPC-E/M, owner of Merrill Medical Management in Saginaw, Mich., in the http://AudioEducator.com audioconference "Code Correctly for Albuterol: Master the J Code Switch" on May 5, 2008.

Keep up: CMS replaced J7611-J7614 with Q4093 (Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, noncompounded, administered through DME, concentrated form, per 1 mg [albuterol] or per 0.5 mg [levalbuterol]) and Q4094 (... unit dose ...), which HCPCS 2008 deleted on Dec. 31, 2007.

So far this year, you should have been using J7602 (replaced Q4093) and J7603 (replaced Q4094), which are for albuterol and levalbuterol, all formulations, non-compounded. You chose the correct code based on whether you used the concentrated (J7602) or unit dose form (J7603).

Current: The spring-quarter updates to HCPCS delete J7602-J7603 and reinstate J7611-J7614, effective April 1, 2008.

Why the full circle? CMS wanted to go back to using noncompounded solution codes that differentiate between albuterol and levalbuterol, Merrill tells The Coding Institute. Codes J7602-J7603 lumped the drugs, which didn't make financial sense. CMS pays albuterol and levalbuterol at different amounts using different measurements.

Focus on 2 J7611-J7614 Factors

You can get the correct noncompounded solution supply code if you zoom in on two items:

• form -- concentrated (J7611-J7612) or unit dose (J7613-J7614).

• drug -- albuterol (J7611, J7613) or levalbuterol (J7612, J7614).