Otolaryngology Coding Alert

Tip:  Learn how you should use modifiers KP, KQ

If you-re still reporting inhaled albuterol services using code J7616, you-re likely seeing tons of denials. Follow these three simple steps and watch the albuterol reimbursement begin to roll in again.

1. Eliminate J7616 and J7617 From Your Superbill

Blue Cross and Blue Shield denied one claim for J7616 (Albuterol, up to 5 mg, and ipratropium bromide, up to 1 mg, compounded inhalation solution, administered through DME) because the 2006 HCPCS Level II manual discontinued the code, says Lynn M. Anderanin, CPC, director of coding and appeals for Healthcare Information Services in Des Plaines, Ill.

HCPCS also deleted the other compounded inhalation code, J7617 (Levalbuterol, up to 2.5 mg, and ipratropium bromide, up to 1 mg, compounded inhalation solution, administered through DME).

Reason: CMS decided to revise the codes for albuterol and levalbuterol with ipratropium bromide to eliminate confusion over compounded versus premixed solutions. The new code J7620 (Albuterol, up to 2.5 mg, and ipratropium bromide, up to 0.5 mg, non-compounded) excludes inhalants that a pharmacy or physician compounds, says Elizabeth Spurgin of Aventor Reimbursement in Washington, D.C.

2. Include J7620 as DuoNeb Supply Code

When your staff member administers a nebulizer treatment that contains a compounded inhalation solution of albuterol and ipratropium bromide, you should most likely report the medication with new code J7620. That's because it now describes a single dose of the combined product DuoNeb Inhalation Solution, Spurgin says.

To more accurately reflect the solution's makeup, CMS decided to discontinue J7616 and establish a new J code, according to a CMS-HCPCS workgroup meeting.

Physicians use DuoNeb Inhalation Solution's dual-therapy to treat bronchospasm for patients who require more than one bronchodilator. The product combines two respiratory solutions in one premixed, premeasured, 3-mL unit-dose vial for nebulization: albuterol sulfate (2.5 mg) and ipratropium bromide (0.5 mg).

3. Use Individual Codes for Compounded Solutions

The workgroup also decided to eliminate the other compounded inhalation J code. Code -J7617 does not describe any item or service that is currently on the market, and the existence of this code could encourage inappropriate pharmacy compounding,- Spurgin says in her request to discontinue J7617. CMS agreed and considered J7617 duplicative.

In the past, coders had a hard time deciding  whether to use a single compound code or multiple individual codes.
 
Example: -We mix levalbuterol and ipratropium bromide solutions ourselves,- says Angela McDougal, CCS-P, coding analyst at Bend Memorial Clinic in Bend, Ore. In 2005, the clinic should have reported the solution with the compounded code J7617 rather than the component codes, such as J7613 (Albuterol, inhalation solution, administered through DME, unit dose, 1 mg) and J7644 (Ipratropium bromide, inhalation solution administered through DME, unit-dose form, per mg), or J7614 (Levalbuterol, inhalation solution, administered through DME, unit dose, 0.5 mg) and J7644.

The new method: When coding compounded preparations in 2006, -use individual J codes with modifiers KP (First drug of a multiple-drug unit-dose formulation) and KQ (Second or subsequent drug of a multiple-drug unit-dose formulation),- the workgroup concluded in its preliminary decision.