Primary Care Coding Alert

and levalbuterol: 

More nebulizer news: The March 2005 Family Practice Coding Alert article on new inhalation J codes discusses the four individual nebulizer medication codes (J7611-J7614) that replace albuterol and levalbuterol codes J7618 and J7619.
 
The article, however, didn't mention albuterol/levalbuterol with ipratropium bromide codes J7616 and J7617, says Angela McDougal, CCS-P, coding analyst at Bend Memorial Clinic in Bend, Ore.

Old way: When a family physician (FP) administered a nebulizer treatment containing a compounded inhalation solution of albuterol and levalbuterol, you should have assigned J7621 (Albuterol, all formulations, including separated isomers, up to 5 mg [albuterol] or 2.5 mg [levalbuterol], and ipratropium bromide, up to 1 mg, compounded inhalation solution, administered through DME). HCPCS 2005 deletes this J code.

New way: You should now specify whether the FP uses a compounded inhalation solution of: 

Bill Premixed Solution With Compounded Code

Codes J7616 and J7617 may come in handy more than you think. Even if you premix albuterol/levalbuterol and ipratropium bromide, you should still use these new compounded inhalation solution J codes, says Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.

Reason: "Medicare implies that premixed and compounded are synonymous," Moore says. In the 2005 fee schedule proposed rule (see page 61 of the document at www.cms.hhs.gov/providers/drugs/mpfs_05pr.pdf) CMS talks about suppliers furnishing albuterol and ipratropium bromide in "a premixed form (either commercially premixed or pharmacy-compounded)."

"So if a physician's office (like a pharmacy) mixes the two and administers them, they should use the compounded inhalation solution codes: J7616 or J7617,"  Moore says.

Example: "We mix levalbuterol and ipratropium bromide solutions ourselves," McDougal says. The clinic orders premixed albuterol and ipratropium bromide.

The clinic should use the compounded codes for either solution (J7616-J7617), rather than the component codes, such as J7613 and J7644 (Ipratropium bromide, inhalation solution administered through DME, unit dose form, per mg) or J7614 and J7644.