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Bill 94640 and appropriate revenue code for hand-held nebulizer

APCs Weekly Monitor, January 6, 2006

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Bill 94640 and appropriate revenue code for hand-held nebulizer

QUESTION: How do you charge for a hand-held nebulizer that contains a drug such as Albuterol? A nurse uses this device in the outpatient hospital setting, and it's not a "prescription." Do the drug codes, for example J7613 (Albuterol, inhalation solution, administered through DME, unit dose, 1 mg), include the use of the device? We are not durable medical equipment (DME) certified, so we cannot bill our FI for "E" codes for the device.

ANSWER: Typically, when a nurse administers a hand-held nebulizer that contains a drug such as Albuterol, the nurse is following a physician's order for inhalation treatment (CPT 94640, Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes). In this instance, the drug is part of the treatment and is therefore covered under Part B, or OPPS.

You cannot bill code J7613 in this scenario because the nebulizer is not considered DME. The definition of DME can be found in the Medicare Benefit Policy Manual, chapter 15, section 110.1. You can read it at this Web site: http://www.cms.gov/manuals/102_policy/bp102c15.pdf on p. 92. According to the manual, durable medical equipment is equipment that:

• Can withstand repeated use;
• Is primarily and customarily used to serve a medical purpose;
• Generally is not useful to a person in the absence of an illness or injury; and
• Is appropriate for use in the home.

For an item to be considered DME, it must be used in the home. This is not the case with outpatient hospital nebulizer inhalation treatment. Therefore, report the appropriate procedure code, 94640. There is no appropriate HCPCS code for the Albuterol, therefore, report it as a packaged drug using revenue code 250.

Note that some FIs have specific policies for this service. Make sure you document the medical necessity of the inhalation treatment in the medical record to support your billing (i.e., documentation of an acute patient episode requiring immediate nebulizer treatment).

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