Otolaryngology Coding Alert

Bonus: Don't let premix and compound solution requirements mix you up You now have greater flexibility in code selection when report inhalation solutions, thanks to HCPCS 2005 introducing six new J codes. Take Your Pick of New Nebulizer Med Codes This year you have two new codes for compounded inhalation solutions:

 J7616 - Albuterol, up to 5 mg and ipratropium bromide, up to 1 mg, compounded inhalation solution, administered through DME 
 J7617 - Levalbuterol, up to 2.5 mg and ipratropium bromide, up to 1 mg, compounded inhalation solution, administered through DME. HCPCS 2005 introduces J7616-J7617, along with J codes for albuterol:
 J7611 - Albuterol, inhalation solution, administered through DME, concentrated form, 1 mg 
 J7613 - Albuterol, inhalation solution, administered through DME, unit dose, 1 mg and levalbuterol:
 J7612 - Levalbuterol, inhalation solution, administered through DME, concentrated form, 0.5 mg
J7614 - Levalbuterol, inhalation solution, administered through DME, unit dose, 0.5 mg.

Old way: When a physician administered a nebulizer treatment containing a compounded inhalation solution of albuterol and levalbuterol, you should have assigned J7621 (Albuterol, all formulations, including separated isomers, up to 5 mg [albuterol] or 2.5 mg [levalbuterol], and ipratropium bromide, up to 1 mg, compounded inhalation solution, administered through DME). HCPCS 2005 deletes this J code.

New way: You should now specify whether the allergist uses a compounded inhalation solution of:
 albuterol and ipratropium bromide - J7616
 levalbuterol and ipratropium bromide - J7617. Bill Premixed Solution With Compounded Code Codes J7616 and J7617 may come in handy more than you think. Even if you premix albuterol/levalbuterol and ipratropium bromide, you should still use these new compounded inhalation solution J codes, says Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.

Reason: "Medicare implies that premixed and compounded are synonymous," Moore says. In the 2005 fee schedule proposed rule (see page 61 of the document at www.cms.hhs.gov/providers/drugs/mpfs_05pr.pdf), CMS talks about suppliers furnishing albuterol and ipratropium bromide in "a premixed form (either commercially premixed or pharmacy-compounded)."

"So if a physician's office (like a pharmacy) mixes the two and administers them, they should use the compounded inhalation solution codes: J7616 or J7617," Moore says.

Example: "We mix levalbuterol and ipratropium bromide solutions ourselves," says Angela McDougal, CCS-P, coding analyst at Bend Memorial Clinic in Bend, Ore. The clinic orders premixed albuterol and ipratropium bromide.

The clinic should use the compounded codes for either solution (J7616-J7617) rather than the component codes, such as J7613 and J7644 (Ipratropium bromide, inhalation solution administered through DME, unit dose form, per mg) or J7614 and J7644.