CMS flip flops on 2004 respiratory HCPCS codes

Saturday, January 31, 2004

WASHINGTON - CMS rolled out an extensive revision to the coding for respiratory drugs in December and then quickly pulled it back.

The new HCPCS code J7621, which went into effect Jan. 1, covers all combinations of albuterol sulfate and ipratropium bromide (namely DuoNeb) administered through a DME,

The original J7621 code announced in December was going to include compounded solutions of the two respiratory drugs as well, however, January’s revision said compounds should continue to be billed using J7619 for albuterol and J7644 for ipratropium with appropriate KO, KP and KQ modifiers.

“The DMERCs were very clear in how they wanted drug combinations to be coded, now it appears they want billing to be done exactly the same way it always has, except for DuoNeb product,” said one industry insider.

The J7621 code will be reimbursed at $1.70 per dose, according to Mickey Letson, president of Letco Medical. A typical compounded dose of albuterol 2.5m with Ipratropium .5m will be reimbursed one cent more at $1.71.