Pediatric Coding Alert

Question: Our pediatricians think we should bill A7005 each time we use the nebulizer set. But, we use the same set over and over and just clean it in-between sessions. Wouldn't the patient actually have to leave with the set for us to bill for it, or the item be discarded after one use?

California Subscriber

Answer: The HCPCS supply codes describe materials that the patient or your pediatrician uses only once. To bill A7005 (Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable), the pediatrician must sell the set to the patient for home use or throw away the set after using it.

If your pediatrician rents the nebulizer set to patients who do not have chronic asthma, you may direct-bill the patient for the supply, if your contract allows it. In this case, you would not use a HCPCS code. You should instead contact the carrier and see if it has a specific code that allows you to charge the patient a predetermined price per day for renting the nebulizer set.