Report Reinstated Albuterol, Levalbuterol Codes to Avoid Denials
Published on Thu Jun 26, 2008
Payers are already accepting 'new' HCPCS 2008 J codesIf you're after a nebulization treatment's medication cents, you're going to have to update your coding -- again.Your 2008 superbill should be fresh off the presses from its changes to albuterol/levalbuterol codes J7602 (Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, noncompounded, administered through DME, concentrated form, per 1 mg [albuterol] or per 0.5 mg [levalbuterol]) and J7603 (... unit dose ...). You'll now need to shift the supply codes back to:• J7611 -- Albuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, concentrated form, 1 mg• J7612 -- Levalbuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, concentrated form, 0.5 mg• J7613 -- Albuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose, 1 mg• J7614 -- Levalbuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose, 0.5 mg.For instance, in March, "We were using J7603 for albuterol," says Diane Nelson, RTR, CPC, medical coder for Vanguard Medical Services in Frederick, Md. In April, "We changed back to J7613." The CMS fee schedule Web site recognizes J7611-J7614 and not J7602-J7603.Switch Back to Drug-Specific CodesYou may remember that you previously removed J7611-J7614 from your encounter sheet. HCPCS 2007 added these codes and swept them away just six months later. CMS deleted J7611-J7614, effective July 1, 2007, says Denae M. Merrill, CPC-E/M, during AudioEducator.com's audioconference "Code Correctly for Albuterol: Master the J Code Switch" on May 5, 2008.Keep up: CMS replaced J7611-J7614 with Q4093 (Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, per 1 mg [albuterol] or per 0.5 mg [levalbuterol]) and Q4094 (... unit dose ...), which HCPCS 2008 deleted on Dec. 31, 2007. So far this year, you should have been using J7602 (replaced Q4093) and J7603 (replaced Q4094), which are for albuterol and levalbuterol, all formulations, noncompounded. You chose the correct code based on whether you used the concentrated (J7602) or unit dose form (J7603).Current: The spring-quarter updates to HCPCS 2008 delete J7602-J7603 and reinstate J7611-J7614, effective April 1.Why? CMS wanted to go back to using non-compounded solution codes that differentiate between albuterol and levalbuterol, says Merrill, who owns Merrill Medical Management in Saginaw, Mich. "Codes J7611-J7614 offer better descriptors (four options) than J7602-J7603, which bundled the different medications together (only two options)."Focus on 2 J7611-J7614 FactorsYou can get the correct noncompounded solution supply code if you zoom in on two items:• form -- concentrated (J7611, J7612) or unit dose (J7613, J7614).• drug -- albuterol (J7611, J7613) or levalbuterol (J7612, J7614).Make an Across-the-Board SwitchBecause private payers seem to be following Medicare's lead, start using J7611-J7614 for all payers. "Several Blue Cross Blue [...]
