TriCenturion, the DMAC for regions A and B, released a bulletin last week detailing the code changes and revised billing instructions for nebulizer drugs.
The 2007 HCPCS update reflected a major change to distinguish FDA-approved, non-compounded final products from compounded inhalation solutions.
According to the bulletin, “A compounded inhalation solution is one in which the product that is delivered to the patient is not an FDA-approved preparation. It is produced by a pharmacy that is not an FDA-approved manufacturer and involves the mixing, combining or altering of ingredients. Even if one the ingredients is an FDA-approved product (e.g., an injectable form of the drug), if that is mixed by the pharmacy with other ingredients, the solution that is dispensed to the patient is considered to be a compounded product.”
The bulletin contains a narrative description of all nebulizer drug codes effective for dates of service on or after Jan. 1, 2007. For a complete list of codes, visit www.tricenturion.com/content/currentbulletin_dyn.cfm.
Also included are updates on invalid codes:
- The following codes do not have FDA-approved final products and are invalid for claim submission (including any combination of these codes and a KO, KP or KQ modifier): J7633 (budesonide, concentrate), J7648 (isoetharine, concentrate), J7649 (isoetharine, unit dose), J7658 (isoproterenol, concentrate), J7659 (isoproterenol, unit dose) and J7668 (metaproterenol, concentrate).
- Codes J2545 (pentamidine), J7608 (acetylcysteine), J7631 (cromolyn), J7639 (dornase alpha), and Q4080 (iloprost) may only be used for inhalation solutions which are FDA-approved. Compounded versions of these drugs must be billed using code J7699.
- The only FDA-approved unit dose preparation containing more than one drug is the combination of albuterol and ipratropium (e.g., DuoNeb), which has a unique code, J7620. Because of this change, the following FDA-approved unit dose codes billed with a KP or KQ modifier will be rejected as invalid for claim submission: J7608, J7613, J7614, J7631, J7639, J7644, J7649, J7659, J7669 and J7682.
The bulletin further stated that the following codes for FDA-approved concentrate and unit dose inhalation solutions will remain valid: J2545, J7608KO, J7611, J7612, J7613KO, J7614KO, J7620, J7626KO, J7631KO, J7639KO, J7644KO, J7669KO, J7682KO and Q4080.
Codes for compounded unit dose inhalation solutions will continue to be billed using the KO, KP and KQ modifiers. For dates of service on or after Jan. 1, 2007, when billing for compounded unit dose inhalation solutions containing more than one drug, the supplier may put the KP modifier on any one of the drugs and the KQ modifier on the other(s).
Code J7699 (not otherwise classified inhalation solution) will continue to be used when billing for drugs in inhalation solutions that do not have a specific HCPCS code.
