Pediatric Coding Alert

Key: Get your nebulizer claims on track and slash denials

If your payers have started denying your claims for inhaled albuterol code J7616, don’t lose hope. You can refile those claims with a new HCPCS Code that will help keep your nebulizer reimbursement rolling in.

Follow three simple steps, and you’ll find out how to tackle albuterol coding challenges at last.

1. Eliminate J7616, J7617 Listings From Superbill

Blue Cross and Blue Shield denied one subscriber’s claims 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.

2. Include J7620 as DuoNeb Supply Code

When your pediatric 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. Code J7620 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. Pediatricians use DuoNeb Inhalation Solution’s dual-therapy to treat bronchospasms 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.