Pulmonology Coding Alert

Question: May we bill private payers for a syringe code with a vaccine administration code? Also, may I report nebulizer supplies such as the mask, mouthpiece and tubing with a nebulization?


Georgia Subscriber

Answer: The answer is no to both questions. You should not bill for a syringe using codes A4206 (Syringe with needle, sterile 1 cc, each) or A4208 (Syringe with needle, sterile 3 cc, each), in addition to vaccine administration (90465-90474).

You also shouldn't bill a mask (A7015, Aerosol mask, used with DME nebulizer) or mouthpiece (A4617) and tubing (A4616, Tubing [oxygen], per foot]) with a nebulization (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]).

Why: The practice expense for vaccine administration codes and the nebulizer treatment code includes the related equipment, such as the syringe, mask, mouthpiece or tubing.

You may, however, code the medication albuterol (Ventolin, Proventil) or levalbuterol (Xopenex). Report concentrated forms with J7611 (Albuterol, inhalation solution, administered through DME, concentrated form, 1 mg) or J7612 (Levalbuterol, inhalation solution, administered through DME, concentrated form, 0.5 mg).

For premixed or unit-dose forms, report J7613 (Albuterol, inhalation solution, administered through DME, unit dose, 1 mg) or J7614 (Levalbuterol, inhalation solution, administered through DME, unit dose, 0.5 mg).

Caution: Some insurers bundle the J codes into 94640. Be sure to check with individual carriers before reporting the J codes along with the nebulizer treatment code.