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Thread: nebulizer reimbursement (94640)

  1. #1

    Question nebulizer reimbursement (94640)

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    Hello all!

    Here in my office we give nebulizer treatments 94640. We give this with the medication albuteral J7613 most often, and we sometimes also give the treatment with atrovent J7644 in addition to the albuteral. But we are not really getting reimbursed for the nebulizer treatments if anything at all, we have been getting a lot of denials.

    Does anyone have any ideas, secrets, tricks etc on how we can improve are billing of this or what we can do different or in addition to to get reimbursement?

    If anyone can get back to me soon!

    Thank You-
    Jackie

  2. #2
    Join Date
    Apr 2007
    Location
    Greensboro
    Posts
    55

    Default Neb treatments

    Hey Jackie,

    We are not getting paid for the medication Albuteral. Medicaid and Medicare states that they will reimburse for another medication that is used for nebulizer. It is generic medication for Albuteral.
    [I]Elizabeth Comma-Watson, CPC
    Billing/Coding Specialist
    Greensboro, NC 27455-2601

  3. #3
    Join Date
    Apr 2007
    Location
    Alexandria, VA
    Posts
    390

    Smile

    Quote Originally Posted by jsa1517 View Post
    Hello all!

    Here in my office we give nebulizer treatments 94640. We give this with the medication albuteral J7613 most often, and we sometimes also give the treatment with atrovent J7644 in addition to the albuteral. But we are not really getting reimbursed for the nebulizer treatments if anything at all, we have been getting a lot of denials.

    Does anyone have any ideas, secrets, tricks etc on how we can improve are billing of this or what we can do different or in addition to to get reimbursement?

    If anyone can get back to me soon!

    Thank You-
    Jackie


    Make sure you are using a 25 modifier on your e/m showing that other services were done. We are in a peds office and we get paid for the treatment and med.
    Yolanda T. Haskins CPC, CRC, OHCC
    AAPCCA Board of Directors 2014 - 2017
    Region 1 - NorthEast - ME, NH, VT, MA, RI, CT, NY


    Yolanda.Haskins@aapcca.org

    Alexandria, VA Chapter


    ~ Practice Kindness ~

  4. #4

    Default

    thanks for your replies.. encomma-watson, do you know what that generic medication for Albuteral is? Do you use this generic in your facility?

    Get back to me when you can! Thank You-

  5. #5

    Default

    oh yea, we most definitely use modifier 25, we are sure about that! We love modifiers hehe. Thanks, if you get any other information or find anything else out about other reimbursement for the nebulizer, I would love for you to share it!

    Thank You-

  6. #6

    Default

    albeuterol is generic. atrovent is ipatropium bromide. I bill those and still cannot get paid for the medication. I use the modifier 25 as well. We get paid for the nebulizer but not the medication. I don't know what to do about that. Anyone have a specific J code that they have gotten paid?

  7. #7
    Join Date
    Apr 2007
    Location
    Seacoast- Dover New Hampshire
    Posts
    605

    Default

    Does anyone use the NDC # for the medication?
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  8. #8

    Default

    I always use the ndc codes. BCBS of texas told us that it would be a requirement.

  9. #9
    Join Date
    Apr 2007
    Location
    Greensboro
    Posts
    55

    Default Reimbursement

    How we bill is with both the 25 and 59 modifiers, the albuteral J code (which medicaid of NC will not reimburse). Medicaid stated to me that we have to use the generic of Albuteral which is Atrovent - which is costly to our office (I think) or Duoneb.
    [I]Elizabeth Comma-Watson, CPC
    Billing/Coding Specialist
    Greensboro, NC 27455-2601

  10. #10

    Default

    Quote Originally Posted by encomma-watson View Post
    How we bill is with both the 25 and 59 modifiers, the albuteral J code (which medicaid of NC will not reimburse). Medicaid stated to me that we have to use the generic of Albuteral which is Atrovent - which is costly to our office (I think) or Duoneb.
    just to make sure I understand what you are saying encomma-watson.. so you use both the 25 & 59 modifiers.. you put the -25 to the office visit obvioulsy and -59 to the medication or -59 to the nebulizer.. We put the -59 to the nebulizer & do get paid, we just can't get the darn medication paid..

    Do you get any reimbursement when the atrovent J code is billed with the neb vs albuteral J code billed with neb? even though as you mentioned atrovent is the generic for albuteral? I am just curious because our Doctors give neb treatments often.

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