Pulmonology Coding Alert

Question: What J code should I report for the medication that we administer in the metered-dose inhaler (MDI) bronchodilator during a bronchospasm evaluation (94060)? We use albuterol, Maxair or Combivent MDI.


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Answer: When a nurse uses an MDI bronchodilator, such as the Maxair inhaler, for pre- and post-bronchodilator administration (94060, Bronchodilation responsiveness, spirometry as in 94010, pre-and post-bronchodilator administration), the code's practice expense relative value units include the bronchodilator dose (such as two-three puffs of a 200-puff canister of pirbuterol).

Example: In a pulmonary function lab, a staff member uses a Combivent MDI to deliver the bronchodilator for a 94060 test. You should not bill separately for the ipratropium and albuterol aerosol medication delivered from the Combivent MDI's canister.

Exception: If you instead use a nebulizer to administer an inhalation solution, such as albuterol or albuterol/ipratropium bromide, you should report the solution with the appropriate J code. Although the practice expense of 94060 includes the nebulization of the bronchodilator, the bronchodilator solution is not included. So you can charge the appropriate J code for the bronchodilator.

Remember: You should bill for only physician-purchased supplies in an office setting. Do not charge for supplies that a patient or facility purchases or for samples' use.

Option 1: HCPCS 2007 lists several codes for albuterol. The J codes for a unit dose of albuterol are:

• J7609--Albuterol, inhalation solution, compounded product, administered through DME, unit dose, 1 mg (This is a new code for 2007.)

• J7613--Albuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose, 1 mg (Use this code for Accuneb, Proventil, Respoirol and Ventolin, according to HCPCS 2007.)

Option 2: For the combination of albuterol and ipratropium bromide, you should use J7620 (Albuterol, up to 2.5 mg, and ipratropium bromide, up to 0.5 mg, FDA-approved final product, noncompounded, administered through DME).

Answers to You Be the Coder and Reader Questions answered/reviewed by Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta; and Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.