Pulmonology Coding Alert

Question: Our office has received enquiries for administration of Albuterol/levalbuterol inhalation solution. How should I bill for it? Are there any issues with getting reimbursed for it?

Missouri Subscriber

Answer:  For providing Albuterol/levalbuterol inhalation services, Medicare recognizes the following code choices:

• 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.

These are noncompounded (ready-made) dosages and should be administered directly to the patient. For administering compounded medication (dosage mixed from individual ingredients by a pharmacist in order to tailor it to a patient’s needs), you should report the following the code combos:

• J7609 -- Albuterol, inhalation solution, compounded product, administered through dme, unit dose, 1 mg

• J7610 -- Albuterol, inhalation solution, compounded product, administered through dme, concentrated form, 1 mg

For correctly reporting the inhalation solution codes, you can use the following guide that will help you decide the code:

• Form -- If concentrated (J7610, J7611, J7612) or unit dose (J7609, J7613, J7614).

• Drug -- albuterol (J7609, J7610, J7611, J7613) or levalbuterol (J7612, J7614).

However, keep in mind that you cannot bill accessory supplies such as 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) when you provide an inhalation service. You can only bill for the medication as discussed earlier. If you practice in an outpatient hospital setting, and you report place of service 22 on your claims, the facility will be billing for the medication since they are the typical supplier if the medication. The physician can only bill for drugs that represent a direct cost to the practice.