Pulmonology Coding Alert

Question: The pulmonologist's staff performs pressurized inhalation treatment with a nebulizer. May I report nebulizer supplies such as the mask, mouthpiece and tubing separately?

Georgia Subscriber

Answer: Do not bill for the mask (A7015), mouthpiece (A4617), or tubing (A4616) with a nebulization. The practice expense for the vaccine administration codes and the nebulizer treatment code includes the related equipment, such as the syringe, mask, mouthpiece, or tubing.

For the nebulizer treatment, report 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]).

You may, however, code the medication, such as albuterol (Ventolin, Proventil) or levalbuterol (Xopenex), if your pulmonologist uses them. Report concentrated solution forms with J7610 (Albuterol, inhalation solution, compounded product, administered through DME, concentrated form, 1 mg) or J7607 (Levalbuterol, inhalation solution, compounded product, administered through DME, concentrated form, 0.5 mg).

For premixed or unit-dose forms of albuterol or levalbuterol, report J7609 (Albuterol, inhalation solution, compounded product, administered through DME, unit dose, 1 mg) or J7615 (Levalbuterol, inhalation solution, compounded product, administered through DME, unit dose, 0.5 mg).

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