Health Information Management

Use revenue code plus CPT, without HCPCS, to bill albuterol or Duoneb via nebulizer

APCs Insider, October 31, 2008

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Q. How should we code and bill for unit doses of albuterol or Duoneb solution provided via nebulizer in our hospital outpatient department under a physician's order? Should we bill without a J code, using a 250 revenue code, because it's inherent to the procedure?

Also, how should we code metered dose inhalers (MDIs) used therapeutically to treat outpatients? We typically treat with the MDI and, if it works, we send it home with the patient. Note: We are not DME certified.

A. The HCPCS codes for medications provided via nebulizer have either status indicator of E or M in Addendum B. Hospital providers cannot report these codes. However, if the specific drug is ordered and documented, providers may bill it under revenue code 250 without a HCPCS code. Report the actual treatment with the appropriate CPT code for the nebulizer treatment. You may report treatment using MDIs with a CPT code if administered by hospital staff.

 

However, the MDI itself is usually considered a self-administered drug for outpatients or a non-covered take home-drug if you send the remainder of the inhaler home with the patient for administration by either the patient or a family member.



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