Wednesday, April 30, 2003

No more MDI litmus test for nebs
With Lisa Smith

Q: I’ve heard that nebulizer drug claims are being audited and overpayments are being assessed on the basis of a lack of documentation that the physician tried / considered a metered dose inhaler (MDI) prior to prescribing a nebulizer. What can my company do to avoid such an overpayment?

A: Hopefully, recent changes made by the DMERCs will eliminate your concern. Effective April 1, 2003, the Nebulizer Medical Policy has been revised to remove the following language referencing the MDI consideration requirement:

For criterion (a) [necessary to administer beta-adrenergics, anticholinergics, corticosteroids, and cromolyn for the management of obstructive pulmonary disease] to be met, the physician must have considered use of a metered dose inhaler (MDI) with and without a reservoir or spacer device and decided that, for medical reasons, it was not sufficient for the administration of needed inhalation drugs. The reason for requiring a small volume nebulizer and related compressor/generator instead of or in addition to an MDI must be documented in the patient’s medical record and be available to the DMERC on request.

Therefore, for dates of service on or after April 1, 2003, a supplier need not be concerned with attempting to determine whether the physician first tried / considered an MDI.

What is not yet clear is whether this policy change will also eliminate the assessment of overpayments on the basis of the deleted provision for dates of service prior to April 1, 2003. I believe that the removal of this language from the Nebulizer Medical Policy is strong evidence that such overpayments are not appropriate.

— Lisa Smith is a healthcare attorney with Brown & Fortunato at 830-896-0018.