Pediatric Coding Alert

Let payer steer your inhalation solution supply coding Before you bill for your next nebulizer treatment dose, you'd better check payers' policies -- or risk nonpayment. When discussing coding for asthmatic treatment sessions, you're bound to hear about new Q codes floating around for albuterol. Should you use them? Cut through the confusion with these fast facts. #1: Medicare Now Requires Q4093-Q4094 For some payers, you might be able to forget the J codes you just learned two short years ago. CMS is changing the HCPCS level-II codes associated with albuterol and levalbuterol again. Effective July 1, 2007, Medicare Part B carriers will no longer pay for: • J7611 -- Albuterol, inhalation solution, FDA-approved final product, non-compounded, 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, non-compounded, administered through DME, unit dose, 1 mg • J7614 -- Levalbuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose, 0.5 mg. New way: When a practice purchases and provides inhalation solution for a nebulizer 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) and for pre/post spirometry (94060, Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) due to asthma exacerbation (478.0), carriers instead require: • 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) • Q4094 -- Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, per 1 mg (Albuterol) or per 0.5 mg (Levalbuterol). Time-saver: You can overlook the Q codes' lengthy descriptors and zoom in on one factor: the inhalation solution's form. The only difference between the new inhalation solution Q codes is that Q4093 is for the concentrated form and Q4094 is for unit dose, says Richard H. Tuck, MD, FAAP, a pediatrician at PrimeCare in Zanesville, Ohio. Although the new Q codes come from Medicare, other insurers may adopt them. For instance, Blue Cross and Blue Shield of Minnesota and Blue Plus are implementing the albuterol supply code changes, effective July 1, 2007. #2: J Codes May Be Gone, But Not Deleted Not all insurers may be so swift to replace J7611-J7614 with Q4093-Q4094. Non-Medicare Part B insurers may still accept the current J codes, says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania Department of Medicine in Philadelphia. Why: [...]