Pediatric Coding Alert

You may scoff at taking the time to bill for nebulizer supply codes that reimburse about $1, but the pennies add up. Although nebulizer drug (J7618-J7619, J7644) and medical supply (A7003, A7005, A7015) codes may not pay a lot, you should take the time to bill for these extra items, if the payer permits it. Pediatricians often underutilize the HCPCS Codes (Healthcare Common Procedure Coding System) Level II codes. But, the alphanumerical national codes, which Medicare, Medicaid and most private payers require, allow physicians to capture reimbursement for office supplies. Despite the coding system, some coders wonder whether carriers really reimburse for supply codes billed with nebulizer treatments. Most insurers pay for J7619 (Albuterol, all formulations including separated isomers, inhalation solution administered through DME, unit dose, per 1 mg [Albuterol] or per 0.5 mg [Levalbuterol]), says Valerie Frederick, president/owner of Physicians Services, a medical billing service in Cumming, Ga., whose clients include Ivy Ridge Pediatrics, a busy one-physician practice in Cumming. "Carriers pay a very low amount (approximately 10 percent of our charge)." But Frederick admits, "Alittle is better than nothing." At least the reimbursement covers the cost. So, now that you're convinced that you should bill for pennies, how do you do it? (For a complete list of applicable codes and reimbursement, see "Check Out the Nebulizer Supplies Coding Cheat Sheets" in article 2.) Report Drug With a J Code You should bill for the medication used in the inhaler with the appropriate HCPCS J code, says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C.

Common drugs used in a nebulizer include various forms of albuterol (Ventolin, Proventil) and levalbuterol (Xopenex). Select the supply code based on the medication's form. For concentrated forms, assign J7618 (Albuterol, all formulations including separated isomers, inhalation solution administered through DME, concentrated form, per 1 mg [Albuterol] or per 0.5 mg [Levalbuterol]), says Angela L. Mohun, CPC, a coder/trainer for Physicians Associates, an 80-physician group practice serving adults and children in Central Florida. For premixed or unit-dose forms, report J7619. "Depending on how many treatments the pediatrician provides, bill the J codes in units as well," Mohun says. For J7618 and J7619, you should bill 1 unit per 1 milligram of albuterol and 2 units per 1 milligram of levalbuterol. For instance, a pediatrician administers two inhalation treatments (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]) containing concentrated albuterol. Report J7618 x 2, one unit per 1 milligram concentrated dose. If the pediatrician used the unit-dose form of albuterol, [...]