Pulmonology Coding Alert

Beware:

Private Payers May Still Accept J7611-J7614

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You can get paid for albuterol and levalbuterol supply without a hitch if you use a three-tiered approach.

Realize J Codes Are Gone Only for Medicare

Although J7611-J7614 are invalid for Medicare, not all insurers may replace J7611-J7614 with Q4093-Q4094. Non-Medicare Part B insurers may still accept the current J codes, says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.

Why: The AMA has not deleted the J codes, Pohlig says. "Therefore, J7611-J7614 are still fair game for non-Medicare Part B payers."

Code Inhalation Solution 3 Ways

Until the J Codes are deleted from the HCPCS manual, you'll have to use the payer-preferred supply code. Expect to report albuterol/levalbuterol supply one of three ways:

Method 1: Private payers that never use the HCPCS codes and only use standard CPT codes will require 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]).

Method 2: For non-Medicare Part B insurers that continue to accept the J codes, continue to use J7611-J7614.

Method 3: Use Q codes for plans such as Blue Cross and Blue Shield of Minnesota and Blue Plus that implement the albuterol HCPCS level-II code switch immediately.

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