Billing for nebulizer treatment with albuterol

[EricaCR]

Hello,

I am the biller for a small office in Washington state. We very occasionally administer albuterol to patients via nebulizer in office. I have not had any formal billing training so I am unsure of how best to code to get paid for the nebulizer treatment as well as the albuterol. What I have been billing is:
- an E/M code for the visit with a 25 modifier
- a 94640 for the nebulizer treatment
- a J7611 for the albuterol, with the NDC code and units and price, with a 59 modifier
I recently had the J7611 denied but am unsure why. Can someone let me know where I'm going wrong?

-- Erica R.

 

[Brenda1973]

Its been a few years since I coded these but I did what you are doing except I DID NOT add modifier 59 on the J7611. I also used a different J code for the albuterol I think it was J7620 as that is the formula my provider used. Maybe try removing the 59 modifier and double check the J7611. Good luck!

 

[Angela8700]

hi, I am a student member and still learning. I can't be of much help but I did look up the hcpcs code j7611 and noticed that its highlighted in green which means it has special coverage instructions. it also has the letter M and a check mark.

the check mark means quantity alert that says hcpcs reports quantities that may not coincide with quantities available in the marketplace. the M means items and services not billable to the MAC.. or maybe the modifier 59 was not needed because i thought modifier 25 explained the inhalation treatment for that day.. You may have known all this already but hopefully it could help lead to the solution