Internal Medicine Coding Alert

Published on Mon Aug 23, 2004 PDF

Question: Can we get reimbursed for drugs (e.g., J7619, Albuterol, unit dose) and durable medical equipment (e.g., A4627, Spacer for inhaler) that we use in our physician's office?

Maryland Subscriber

Answer: You can get reimbursed for drugs that represent and incur expenses to the physician. For example, a patient comes in with an acute exacerbation of asthma (493.92, Asthma, unspecified). The nurse administers a bronchodilator via nebulizer (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]).

Depending on the medication the nurse administered, you can report the most appropriate Albuterol code, J7618 (Albuterol, all formulations including separated isomers, inhalation solution administered through DME, concentrated form, per 1 mg [Albuterol] or per 0.5 mg [Levalbuterol]) or J7619 (Albuterol, all formulations including separated isomers, inhalation solution administered through DME, unit dose, per 1 mg [Albuterol] or per 0.5 mg [Levalbuterol]).

Whenever a patient picks up a prescription and brings it to your office for the staff to administer, the physician cannot be reimbursed for the medication administration because the physician did not incur the cost of the drug.

Durable medical equipment represents a different challenge for reimbursement because carriers reimburse only the patient for any expenses personally incurred for DME. To qualify as DME, the equipment must be able to withstand repeated use, be primarily and customarily used to serve a medical purpose, generally not be useful to a person in the absence of an illness or injury, and be appropriate for use in the home. A spacer (A4627, Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler) qualifies as DME, and only a patient can report it for reimbursement.

- Answers for You Be the Coder and Reader Questions were reviewed by Kathy Pride, CPC, CCS-P, a coding consultant for QuadraMed in Port St. Lucie, Fla.; and Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for Rachlin, Cohen & Holtz LLP, a Fort Lauderdale, Fla.-based accounting firm with healthcare expertise.