Pulmonology Coding Alert

You can still get paid for noncompounded solutions, but you'll need to switch to Q codes Before you bill Medicare for your next nebulizer treatment dose, you'd better update your codes -- or risk nonpayment. The first half of 2007 marks a major re-sweep of albuterol and levalbuterol codes. Here are four steps you can't afford to dodge -- and one FAQ that will help your future drug billing. Step 1. Report Noncompounded Solution With Q Code For Medicare, you can forget the J codes for albuterol and levalbuterol that you just learned two short years ago. CMS is once again changing the HCPCS level-II codes associated with these drugs. Effective July 1, 2007, Medicare Part B carriers no longer pay for J7611-J7614, says Christine Martin, CPC, office manager at Fremont Pulmonary Care in Nebraska. New way: You should now use a Q code when billing Medicare for inhalation solution that your practice purchases and provides for a nebulizer treatment (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]) and for pre/post-spirometry (94060, Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration). The new Q codes include: • Q4093 -- Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, noncompounded, administered through DME, concentrated form, per 1 mg (Albuterol) or per 0.5 mg (Levalbuterol) • Q4094 -- Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose, per 1 mg (Albuterol) or per 0.5 mg (Levalbuterol) Step 2. Set Up a Red Flag for 4 J Codes To avoid Medicare claim denials for codes J7611-J7614, mark the codes in your computer system as "invalid for Medicare as of 07/01/07." "Don't delete the codes," which private payers may still accept, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, director of outreach programs for the American Academy of Professional Coders based in Salt Lake City. Designating the codes as invalid for Medicare prevents staff from accidentally assigning the codes to Medicare claims. Codes for albuterol/levalbuterol that are nonpayable by Medicare include: • J7611 -- Albuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, concentrated form, 1 mg • J7612 -- Levalbuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, concentrated form, 0.5 mg • J7613 -- Albuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose, 1 mg • J7614 -- Levalbuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose, 0.5 mg. 3. Replace 4 Superbill Entries With 2 Although CMS doesn't swap one inhalation solution J code with one [...]