Primary Care Coding Alert

Question: Can we collect reimbursement for drugs such as Albuterol that we use in our family physician's office?

Connecticut Subscriber

Answer: You can collect reimbursement for drugs that cause you to incur expenses. For example, a patient comes to your family practice with an acute exacerbation of asthma (493.92, Asthma, unspecified, with [acute] exacerbation). The nurse administers a bronchodilator via nebulizer (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]).

Depending on the medication the nurse administers, you can report the most appropriate Albuterol code, J7618 (Albuterol, all formulations including separated isomers, inhalation solution administered through DME, concentrated form, per 1 mg [Albuterol] or per 0.5 mg [Levalbuterol]) or J7619 (Albuterol, all formulations including separated isomers, inhalation solution administered through DME, unit dose, per 1 mg [Albuterol] or per 0.5 mg [Levalbuterol]).

Tip: If a patient picks up a prescription and brings it to your office for the staff to administer, the physician cannot collect reimbursement for the medication administration, because the physician did not buy the drug.