Don't use J7611-J7614 if you mix med or use sampleAlthough albuterol and levalbuterol J codes have changed, many previous inhalation solution supply "best practices" remain (mostly) the same. Anytime you consider reporting nebulizer medication, follow four guidelines.1. Look Out for Mix, CompoundWatch 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 with only 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 solutions. For compounded (pharmacy- or office-mixed) solutions, 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 solution, which is not FDA-approved. In these cases, you may have to write off the supply cost. Patients who require inhalation treatment for asthma are emergent cases that, due to their clinical nature, may not allow for advance notification and acceptance of financial responsibility or for patient pharmaceutical prescription and purchase.2. Charge for Only Purchased SupplyBefore you charge for noncompounded inhalation solution used in inhalation treatment (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]) or continuous inhalation treatment (94644, Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour), make sure your office purchased the supply."If we use Xopenex (J7612, J7614), we use our sample supply from Sepracor, so we never charge anyone for it," Neff says.3. Use ASP as Payment BenchmarkIf a biller tells you there's no reimbursement for J7611-J7614, tell her to ignore the Medicare Physician Fee Schedule's "X"s. For drug payments, you have to look at the Medicare Part B Drugs Average Sales Price (ASP) file available from
http://www.cms.hhs.gov/home/medicare.asp.You can use CMS' ASP rates, which are based on 85 percent of the wholesale rate, to judge if private insurers' payments are appropriate. The CMS ASP pays non-compounded inhalation solution these amounts:4. Check mg Drug CalculationFor your purchased supply, check the amount of drug administered through the nebulizer or inhalation machine. "Ask, 'How many mg were [...]
