Such is the gap between good intentions and reality.
Treating an asthma exacerbation in a primary care office in most cases achieve great outcomes and reduce the total cost of care. Let's encourage PCPs to be more accessible and expand their services to do this for their patients.
As a PCP I can now go and buy a nebulizer machine and the disposable tubing & mask as well as the albuterol (medicine) we administer through this device.
So far so good. Now comes the crazy part. To be paid for my time and the money we laid out for the equipment and medicine we have to submit a bill.
The billing wars are killing health care.
An email thread from a practice asking the question "How can I get paid for the albuterol I used in the nebulizer as I'm supposed to bill it as a separate line item?" This doctor and nearly every other doctor in the US is participating in this endless and costly warfare.
How is everyone charging the CPT's?
I agree with the article below...
I think the HCPCS: J7619 for albuterol is out of date - but the listing was from 2004.
Anyone billing (and getting paid) for the tubing...HCPCS: A7003 Administration set, with small volume nonfiltered pneumatic
Other codes I've seen for Albuterol include below -- I used J7620 since I used the pre-dosed solution.
but now that I look around on the web, people are using all kinds of J codes for the albuterol.
What do you use?
J7602 - Albuterol inh non-comp con
... j7602 albuterol inh non-comp con ...
J7603 - Albuterol inh non-comp u d
... j7603 albuterol inh non-comp u ...
J7609 - ALBUTEROL COMP UNIT
... j7609 albuterol comp unit albuterol ...
J7610 - ALBUTEROL COMP CON
... j7610 albuterol comp con albuterol ...
J7611 - Albuterol non-comp con
... j7611 albuterol non-comp con albuterol ...
J7613 - Albuterol non-comp unit
... j7613 albuterol non-comp unit albuterol ...
J7616 - ALBUTEROL COMPOUND SOLUTION
... j7616 albuterol compound solution albuterol ...
J7618 - ALBUTEROL INH SOL CON
... j7618 albuterol inh sol con ...
J7619 - ALBUTEROL INH SOL U D
... j7619 albuterol inh sol u ...
J7620 - ALBUTEROL IPRATROP NON-COMP
... j7620 albuterol ipratrop non-comp albuterol ...
An article from PedSource.com says:
Coding descriptions (like usual) aren't clear about whether the cost of the
supplies are "bundled" into the allowance for the nebulizer treatment itself:
CPT: 94640 Pressurized or nonpressurized inhalation treatment for acute
airway obstruction or for sputum induction for diagnostic purposes (eg,
with an aerosol generator, nebulizer, metered dose inhaler or intermittent
positive pressure breathing (IPPB) device)
HCPCS: A7003 Administration set, with small volume nonfiltered pneumatic
HCPCS: J7619 Albuterol, all formulations including separated isomers,
inhalation solution administered through DME, unit dose, per 1 mg
(Albuterol) or per 0.5 mg (Levalbuterol)
We've not used HCPCS code 99070 in a long time because it's non-specific
and usually is either denied by the insurance company or generates a
request for documentation. Once we started using Encoder Pro it became
easy to look up the specific HCPCS codes for medications and medical equipment.
When we give a nebulizer treatment we bill 94640 and A7003 since we do have
to purchase the administration set but we've not billed J7619 since more
often than not we use unit-dose Albuterol that's been provided by a drug
company as an office sample.