Pediatric Coding Alert

Question: We've been getting denials when we report codes J7610 (Albuterol, inhalation solution, compound product, administered through DME, concentrated form 1 mg) and J0570 (Injection, penicillin g benzathine, 100,000 units). Can you advise regarding what the problem might be?

Tennessee Subscriber

Answer: Code J0570 was deleted on January 1, but it crosswalks to new code J0561 (Injection, penicillin G benzathine, 100,000 units), which you should report instead.

Code J7610 is still an active code, but Medicare changed the code's status on the Physician Fee Schedule, which means that private payers may also be following the same value change. The code's status is E, which stands for "Excluded from Physician Fee Schedule by regulation. These codes are for items and/or services that CMS chose to exclude from the fee schedule payment by regulation. No RVUs are shown, and no payment may be made under the fee schedule for these codes. Payment for them, when covered, generally continues under reasonable charge procedures."

Best bet: Contact your payer to determine whether it has stopped assigning payment to J7610.