Pediatric Coding Alert

Question: May a pediatrician's office bill a syringe code with a vaccine administration code to non-Medicare/Medicaid providers? Also, may I report nebulizer supplies such as the mask, mouthpiece and tubing with a nebulization?


Georgia Subscriber

Answer: The answer is no and no. No, you should not code a syringe (A4206, Syringe with needle, sterile 1 cc, each; A4208, Syringe with needle, sterile 3 cc, each) in addition to vaccine administration (90465-90474). You also shouldn't bill a mask (A7015, Aerosol mask, used with DME nebulizer) or mouthpiece (A4617) and tubing (A4616, Tubing [oxygen], per foot]) with a nebulization (94640, Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device). 

Why: The practice expense (PE) for vaccine administration codes and the nebulizer treatment code includes the related equipment, such as the syringe, mask, mouthpiece or tubing.
 
Remember:  You may, however, code the medication albuterol (Ventolin, Proventil) or levalbuterol (Xopenex). Report concentrated forms with either: J7611 Albuterol, inhalation solution, administered through DME,
concentrated form,1 mg J7612 Levalbuterol, inhalation solution, administered through DME,
concentrated form, 0.5 mg.

For premixed or unit-dose forms, depending on the medication used, report either: J7613 Albuterol, inhalation solution, administered through DME, unit dose, 1 mg J7614 Levalbuterol, inhalation solution, administered through DME, unit dose, 0.5 mg.