Pediatric Coding Alert

If you're after a nebulization treatment's medication cents, you're going to have to update your coding -- again.

Your 2008 superbill should be fresh off the presses from its changes to albuterol/levalbuterol codes J7602 (Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, noncompounded, administered through DME, concentrated form, per 1 mg [albuterol] or per 0.5 mg [levalbuterol]) and J7603 (... unit dose ...). You'll now need to shift the supply codes back to:

For instance, in March, "We were using J7603 for albuterol," says Diane Nelson, RTR, CPC, medical coder for Vanguard Medical Services in Frederick, Md. In April, "We changed back to J7613." The CMS fee schedule Web site recognizes J7611-J7614 and not J7602-J7603.

You may remember that you previously removed J7611-J7614 from your encounter sheet. HCPCS 2007 added these codes and swept them away just six months later. CMS deleted J7611-J7614, effective July 1, 2007, says Denae M. Merrill, CPC-E/M, during AudioEducator.com's audioconference "Code Correctly for Albuterol: Master the J Code Switch" on May 5, 2008.

Keep up: CMS replaced J7611-J7614 with Q4093 (Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, per 1 mg [albuterol] or per 0.5 mg [levalbuterol]) and Q4094 (... unit dose ...), which HCPCS 2008 deleted on Dec. 31, 2007. So far this year, you should have been using J7602 (replaced Q4093) and J7603 (replaced Q4094), which are for albuterol and levalbuterol, all formulations, noncompounded. You chose the correct code based on whether you used the concentrated (J7602) or unit dose form (J7603).

Current: The spring-quarter updates to HCPCS 2008 delete J7602-J7603 and reinstate J7611-J7614, effective April 1.

Why? CMS wanted to go back to using non-compounded solution codes that differentiate between albuterol and levalbuterol, says Merrill, who owns Merrill Medical Management in Saginaw, Mich. "Codes J7611-J7614 offer better descriptors (four options) than J7602-J7603, which bundled the different medications together (only two options)."

You can get the correct noncompounded solution supply code if you zoom in on two items:

• form -- concentrated (J7611, J7612) or unit dose (J7613, J7614).

• drug -- albuterol (J7611, J7613) or levalbuterol (J7612, J7614).

Because private payers seem to be following Medicare's lead, start using J7611-J7614 for all payers. "Several Blue Cross Blue Shield companies, as well as Aetna, are back to accepting the J7611-J7614 codes," Merrill says.

UnitedHealthCare is also up to date, Nelson says. UnitedHealthcare paid for J7613 for an April 4, 2008, date of service, and BCBS Texas also paid for J7613 on DOS April 6, she says.

Problems: If insurers reject J7611-J7614, appeal or adjust the codes as needed. For payers that are slow to implement the drug-specific J codes from 2007, remind them that HIPAA requires all insurers to recognize the national coding system, which includes the spring updates to the HCPCS supply codes.

Action: Nudge insurers to update their systems by including in your appeal the explanation that CMS reinstated J7611-J7614 in lieu of J7602-J7603 effective April 1, 2008. Include a copy of these resources:

• HCPCS deleted and approved codes from www.cms.hhs.gov/hcpcsreleasecodesets/02_hcpcs_quarterly_update.asp.

• CMS MLN Matters article at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5981.pdf

• CMS transmittal from http://www.cms.hhs.gov/transmittals/downloads/R1492CP.pdf.