Pulmonology Coding Alert

Surprise: Your albuterol, levalbuterol pay hinges on using HCPCS 2008 crossed-out codesYou 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.Switch Back to Drug-Specific CodesYou 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)."Focus on 2 J7611-J7614 FactorsYou 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).Look Out for Mix, CompoundWatch out for solutions that use ipratropium bromide. For albuterol mixed with ipratropium bromide, use [...]