Big change: Switch to Q codes for albuterol, levalbuterol It's that time of year: time to start adding all the coding updates to your repertoire. First up are the HCPCs code revisions, deletions and additions. Let our experts give you the scoop on which changes will affect you most. Toss Out J7611-J7614 Old way: Effective July 1, your Medicare carriers are no longer paying for J7611-J7614 for nebulized drugs albuterol and levalbuterol, according to MLN Matters article MM5645. New way: You should now use Q4093-Q4094 (Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, non-compounded, administered through DME ...) when billing for inhalation solution that your practice purchases and provides for a nebulizer treatment (94640) and for pre-/post-spirometry (94060). Make sure to mark J7611-J7614 as non-payable for Medicare in your system. Think of Q4093 as replacing J7611-J7612, and Q4094 as replacing J7613-J7614, says Christine Martin, office manager at Fremont Pulmonary Care in Nebraska. Important: Medicare no longer pays for compounded inhalation solutions as of July 1. So before using a compounded solution -- one that is mixed, combined or altered for an individual -- your physician should make sure that he cannot effectively provide the treatment with a noncompounded solution. -If not, provide the patient with information (risks of not pursuing treatment, benefit of following through with treatment, and the financial responsibility involved) so that he may make an informed choice to proceed with treatment,- says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia. The patient does not have to sign an advance beneficiary notice (ABN) for services and items that are excluded from coverage. -ABNs are only required for covered services that are deemed -not medically necessary,- - Pohlig says. -Compounded solutions do not meet this latter description.- On the other hand, you may use an NEMB (Notice of Exclusions From Medicare Benefits) to accomplish the above notification. Although not required, using an NEMB is a good idea for patient information and service. You can find an NEMB at
www.cms.hhs.gov/BNI/11_FFSNEMBGeneral.asp. Payer differences: Remember that some private payers may still accept J7611-J7614, regardless of what Medicare does. And if they do accept those old codes, that's how you should bill the drugs. Capitalize on Better Modifier Descriptors You should also note that the latest HCPCs updates revise modifier GY. The descriptor now reads: -Item or service statutorily excluded, does not meet the definition of any Medicare benefit or for non-Medicare insurers, is not a contract benefit.- CMS added -or for non-Medicare insurers.- CMS also revised modifier KX's descriptor so that it now reads: -Requirements specified in the medical policy have been met.- Other changes [...]
