Pulmonology Coding Alert

Question: Would you tell me what codes I should report for the histamines used in a histamine challenge test? We haven't had any luck getting Medicare to pay for J7699 and the NDC 0044-01.


New Mexico Subscriber

Answer: Because there is no specific J code to accurately reflect the histamine substance, the unlisted inhalation solution code (J7699, NOC drugs, inhalation solution administered through DME) is your only option. The unlisted code doesn't carry a description or a fee, so you and your physician must assign them.

Pulmonologists most frequently perform the bronchospasm provocation challenge with methacholine and less often with histamine. When your pulmonologist provides histamine, your reporting options are limited.

When you submit a claim to Medicare for unlisted drugs and/or services, always include a description and fee on the claim. It is likely Medicare will deny your claim pending review of additionally requested information. Medicare will determine coverage, medical necessity, and payment upon review.

Note: The NDC is an 11-digit National Drug Code that assists in identifying the drug and its manufacturer. Unlisted codes don't have a specific NDC number assigned to them.

Medicare provides coverage for certain drugs used by physicians and providers under certain conditions. You can find the list of Medicare Part B covered drugs and payment at www.cms.hhs.gov/providers/drugs/asp.asp.