Primary Care Coding Alert

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

Georgia Subscriber

Answer: The answer is no and no. You should not code a syringe (A4206, Syringe with needle, sterile 1cc, each; A4208, Syringe with needle, sterile 3cc, 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 all codes include any supply intrinsic in the procedure. Because you always use a mask or mouthpiece and tubing with nebulization, 94640's payment includes the related equipment. Similarly, you always have to use a syringe with vaccine administration. So 90465-90474 include the syringe.
 
Medicine, on the other hand, isn't inherent in a code. The physician must adjust the dose based on patient need. Therefore, you may separately bill the appropriate J code in addition to the pulmonary code.
 
For the nebulization medication, you should report:

  concentrated forms - J7618 (Albuterol, all formulations including separated isomers, inhalation solution administered through DME, concentrated form, per 1 mg [Albuterol] or per 0.5 mg [Levalbuterol])

  premixed or unit-dose forms - J7619 (Albuterol, all formulations including separated isomers, inhalation solution administered through DME, unit dose, per 1 mg [Albuterol] or per 0.5 mg [Levalbuterol]).