Pulmonology Coding Alert

You can avert getting the dreaded nonpayment message "invalid" on EOBs containing rescue medication supply if you revert to using "old" J codes.

Your 2008 superbill should be fresh off the presses from its changes to albuterol/levalbuterol codes J7602 (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]) and J7603 (... unit dose ...). You'll now need to shift the supply codes back to:

• 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.

For instance, in March, "We were using J7603 for albuterol," says Diane Nelson, RTR, CPC, medical coder for Vanguard Medical Services in Frederick, Md. In April, "We changed back to J7613." CMS added J7611-J7614 to its online fee schedule and removed J7602-J7603 from the fee schedule.

You previously removed J7611-J7614 from your encounter sheet. HCPCS 2007 added these codes and swept them away just six months later. CMS deleted J7611-J7614, effective July 1, 2007, says Denae M. Merrill, CPC-E/M, during the AudioEducator.com audioconference "Code Correctly for Albuterol: Master the J Code Switch" on May 5, 2008.

Keep up: CMS replaced J7611-J7614 with Q4093 (Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, per 1 mg [albuterol] or per 0.5 mg [levalbuterol]) and Q4094 (... unit dose ...), which HCPCS 2008 deleted on Dec. 31, 2007.

So far this year, you should have been using J7602 (replaced Q4093) and J7603 (replaced Q4094), which are for albuterol and levalbuterol, all formulations, non-compounded. You chose the correct code based on whether you used the concentrated (J7602) or unit dose form (J7603).

Current: The spring-quarter updates to HCPCS delete J7602-J7603 and reinstate J7611-J7614, effective as of April 1, 2008.

Why? CMS wanted to go back to using non-compounded solution codes that differentiate between albuterol and levalbuterol, Merrill says. "Codes J7611-J7614 offer better descriptors (four options) than J7602-J7603, which bundled the different medications together (only two options)."

You can get the correct noncompounded solution supply code if you zoom in on two items:

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

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

Watch out for solutions that use ipratropium bromide. For albuterol mixed with ipratropium bromide, use J7620 (Albuterol, up to 2.5 mg, and ipratropium bromide, up to 0.5 mg, FDA-approved final product, noncompounded, administered through DME) rather than J7611-J7614.

Inhalation solution solely consisting of ipratropium bromide falls under J7644 (Ipratropium bromide, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose form, per mg). "We use J7644 for Atrovent," says Christy Neff, RMC, billing specialist for Witham Health Services in Lebanon, Ind.

Codes J7611-J7614, J7620 and J7644 are specifically for noncompounded (premixed) inhalation solution. For compounded (pharmacy- or office-mixed) solution, instead look to:

• J7607 -- Levalbuterol, inhalation solution, compounded product, administered through DME, concentrated form, 0.5 mg

• 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

• J7615 -- Levalbuterol, inhalation solution, compounded product, administered through DME, unit dose, 0.5 mg.

Warning: Insurers may follow Medicare's lead and not cover compounded solutions that are not FDA-approved. In these cases, you may have to bill the patient or write off the supply cost. Patients who require inhalation treatment for asthma usually require therapy for emergent situations.

That may not allow for advance notification and acceptance of financial responsibility for the patient's prescription and purchase.

Before you charge for noncompounded inhalation solution used in spirometry with bronchodilator administration (94060), inhalation treatment (94640) or continuous inhalation treatment (94644, 94645), make sure that your office purchased the supply. "If we use Xopenex, we use our sample supply from Sepracor, so we never charge anyone for it," Neff says.

On purchased supply, check the amount of drug administered through the nebulizer or inhalation machine. Ask, "How many milligrams (mg) were given?" Merrill says.

Bookmark: You'll use different notations for albuterol and levalbuterol. For albuterol, you report 1 unit per 1 mg. You should use 1 unit for each 0.5 mg of levalbuterol administered.

Alert: If a biller tells you there's no reimbursement for J7611-J7614 because it is not listed in the Medicare Physician Fee Schedule, tell him to refer to the correct source. For drug payments, you have to look at the Medicare Part B Average Price File at http://www.cms.hhs.gov/home/medicare.asp.