New code covers albuterol-ipratropium combo

Sunday, January 11, 2004

January 12 , 2004

WASHINGTON - A new code was established for combinations of albuterol sulfate and ipratropium bromide inhalation solutions.

The new code, J7621, is effective for dates of service on or after Jan. 1, 2004. The code covers albuterol, all formulations, including separated isomers, up to 5 mg (albuterol) or 2.5 mg (levalbuterol), and ipratropium, up to 1 mg, compounded inhalation solution, administered through DME, according to CMS.

This code may only be used when these drugs are provided in combination by a manufacturer or repackager in a vial with a single NDC number. DuoNeb is one example. Despite the narrative description of the code, J7621 must not be used for compounded inhalation solutions of these drugs. For compounded combination unit dose preparations and for situations in which these drugs are provided in separate unit dose vials, suppliers should continue to bill using code J7619 for albuterol and J7644 for ipratropium with the appropriate modifier – KO, KP, or KQ, according to CMS.

For DuoNeb and other products that meet the definition of J7621, suppliers must use code J7621 for all claims with dates of service on or after 1/1/04. There is no grace period for continuing to use codes J7619 and J7644 for these products.

The KO, KP, and KQ modifiers should not be used with code J7621.

DuoNeb and currently available repackaged products contain 3.0 mg of albuterol sulfate (which is 2.5 mg of albuterol base) and 0.5 mg of ipratropium bromide in each unit dose vial. For these products, 1 unit of service of J7621 = 2 unit dose vials.