Make 3 Changes to Your Nebulizer Coding And Slash Your Denials
Published on Mon Apr 24, 2006
Key: Incorporate the HCPCS Codes 2006 DuoNeb supply code You can keep payment rolling in for inhalation solutions simply by adding one new J code and removing two deleted ones from your encounter sheet.
If you-ve been monitoring your explanation of benefits for nebulizer medication charges, you may have noticed some problems--such as receiving -invalid code- denials from Blue Cross on inhaled albuterol J7616.
Leap over these reimbursement hurdles by taking a few simple precautions. 1. Eliminate J7616 and J7617 Listings From Superbill BCBS is denying claims for J7616 (Albuterol, up to 5 mg, and ipratropium bromide, up to 1 mg, compounded inhalation solution, administered through DME) because the 2006 HCPCS Level II manual discontinued the code, says Lynn M. Anderanin, CPC, director of coding and appeals for Healthcare Information Services in Des Plaines, Ill. HCPCS also deleted the other compounded inhalation code, J7617 (Levalbuterol, up to 2.5 mg, and ipratropium bromide, up to 1 mg, compounded inhalation solution, administered through DME).
Reason: CMS decided to revise the codes for albuterol/levalbuterol with ipratropium bromide to eliminate confusion over compounded versus premixed solutions. The new code J7620 excludes inhalants that a pharmacy or physician compounds, says Elizabeth Spurgin of Aventor Reimbursement. 2. Include J7620 as DuoNeb Supply Code When a staff member administers a nebulizer treatment that contains an inhalation solution of albuterol and ipratropium bromide, you should most likely report the medication with new code J7620 (Albuterol, up to 2.5 mg, and ipratropium bromide, up to 0.5 mg, non-compounded). Code J7620 now describes a single dose of DuoNeb Inhalation Solution, Spurgin says.
To more accurately reflect the solution's make-up, CMS decided to discontinue J7616 and establish a new -J- code, according to a CMS-HCPCS workgroup meeting. Physicians use DuoNeb Inhalation Solution's dual-therapy to treat bronchospasms associated with chronic obstructive pulmonary disease (COPD) for patients who require more than one bronchodilator.
The product combines two respiratory solutions in one premixed, premeasured, 3-mL unit-dose vial for nebulization: albuterol sulfate (2.5 mg) and ipratropium bromide (0.5 mg). 3. Use Individual Codes for Compounded Solutions The workgroup also decided to eliminate the other compounded inhalation -J- code. Code -J7617 does not describe any item or service that is currently on the market, and the existence of this code could encourage inappropriate pharmacy compounding,- Spurgin says in her request to discontinue code J7617. CMS agreed with Spurgin and considered J7617 duplicative.
Coders had a hard time deciding whether to use a single compound code or multiple individual codes.
-Medicare implies that -premixed- and -compounded- are synonymous,- says Kent J. Moore, a healthcare financing manager in Leawood, Kan. In the 2005 fee schedule proposed rule, CMS talks about suppliers furnishing albuterol and ipratropium bromide in -a premixed form (either commercially [...]
