Pulmonology Coding Alert

Experts say it's all in your J7618-J7619 billing

Reporting nebulizer drug codes for a few dollars in reimbursement may seem insignificant, but missing that reimbursement over a year's time could cost your pulmonology practice hundreds of dollars. Use these expert tips to bill for nebulizer drugs (J7618-J7619, J7644) if your payer allows it.

Watch for: Pulmonology coders often underuse J codes. But the alphanumerical national codes, which Medicare, Medicaid and most private payers require, allow physicians to capture reimbursement for drugs and biological supplies.

The different systems leave coders wondering whether carriers really reimburse for supply codes billed with nebulizer treatments.

Most insurers pay for J7619 (Albuterol, all formulations including separated isomers, inhalation solution administered through DME, unit dose, per 1 mg [Albuterol] or per 0.5 mg [Levalbuterol]), says Valerie Frederick, president/owner of Physicians Services, a medical billing service in Cumming, Ga. "Carriers pay a very low amount (approximately 10 percent of our charge)," Frederick says. "But a little is better than nothing."

Bill J7618 for Concentrated Drugs

You should bill for the inhalation solution with the appropriate HCPCS J code, coding experts say.

Common nebulizer drugs include various forms of albuterol (Ventolin, Proventil) and levalbuterol (Xopenex). Select the supply code based on the medication's form.  For concentrated forms, assign J7618 (Albuterol, all formulations including separated isomers, inhalation solution administered through DME, concentrated form, per 1 mg [albuterol] or per 0.5 mg [levalbuterol]), says Angela L. Mohun, CPC, a coder/trainer for Physicians Associates, an 80-physician group practice in Central Florida.

For premixed or unit-dose forms, report J7619. "Depending on how many treatments the physician provides, bill the J codes according to the amount of milligrams used," Mohun says. For J7618 and J7619, you should bill 1 unit per 1 mg of albuterol and 2 units per 1 mg of levalbuterol.

Example: Your pulmonologist administers two inhalation treatments (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]), each containing 1 mg of concentrated albuterol.

Try this: Report J7618 x 2, one unit per 1-mg concentrated dose. If the physician used the unit-dose form of albuterol, you should bill J7619 x 2.

Heads up: When the doctor uses a concentrated inhalation drug, you can no longer bill separately for the saline solution used to dilute it. That's because HCPCS 2004 deleted A7019 (Saline solution, per 10 ml, metered dose dispenser, for use with inhalation drugs).

In addition, HCPCS deleted J7644 (Ipratropium bromide, inhalation solution administered through DME, unit dose form, per mg).

Alternative: You can report new HCPCS code J7621 (Albuterol, all formulations, including separated isomers, up to 5 mg [albuterol] or 2.5 mg [levoalbuterol], and ipratropium bromide, up to 1 mg, compounded inhalation solution, administered through DME) if the physician administers albuterol and atrovent together.