Getting Paid for the Use of Albuterol and Rocephin
Published on Sun Aug 01, 1999
Albuterol, a bronchodilator added to saline and nebulized to treat asthma attacks, isnt expensive. Rocephin, a powerful antibiotic used for severe infections, is expensive. Both of these medications are used commonly in pediatrics. And both involve procedure codes on top of office visit codes, and supply codes as well. What are the best ways to code for administering these medications, bearing in mind that expensive or not, you need to recoup your cost?
Coding for Initial Albuterol Treatment
When you give albuterol by nebulizer, there are two procedure codes you need to be concerned about: CPT 94664 (aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes; initial demonstration and/or evaluation) and 94665 (subsequent).
The first question coders have is, What does initial mean? Because this isnt defined in CPT, insurance companies are interpreting it the way they want to. It should mean the first treatment on a given day, says Keisha Gregory, reimbursement and coding analyst for Practice Solutions, a billing company which specializes in pediatrics in Durham, NC. For her clients, Gregory bills for one unit of 94664, and the number of units of 94665 needed to be done in the case of multiple treatments during a visit. But not all providers are this lucky.
If you are in a state like Florida or California, where managed care is extremely restrictive, you may find companiesand even the governmentdefining initial as being relatively rare. We can only bill 94664 once every six months, says Carmen Cortes, billing coordinator for Island Coast Pediatrics, a six-pediatrician practice in Cape Coral, FL. The six-month guideline is dictated by Medicaid, says Cortes, who follows this guideline for all payers.
The Solution: 94640
It must be remembered that some insurance plans will only pay for 94664 once in a lifetime. Some offer only a trivial reimbursement for 94665. One alternative is to use 94640 (non-pressurized inhalation treatment for acute airway obstruction) for each treatment, according to Thomas Kent, CMM, former office manager of a pediatric practice and principal of Kent Medical Management in Dunkirk, MD. While the reimbursement for 94640 is a little less than 94664, it is significantly greater than 94665, says Kent. So you can use 94640 for each treatment. For example, if a child receives three nebulizer treatments on the same day, you would list 94640 with three units. You also would use an office visit code with the nebulizer codes, says Cortes.
In fact, the definition of 94640 is a more accurate description of the care given to asthma patients by [...]
