CODING Q&A Nebulizer Treatment Coding and Take-backs on 99051 ■ DAVID STERN, MD, CPC Q . Payors do not seem to want to pay on the code E0572 (aerosol compressor, adjustable pressure, light duty for intermittent use). What can we do to get payment? This code is not for simple use of the aerosol com- pressor, but is actually used to code for sale of the actual nebulizer machine. Thus, this code would rarely be appropriate for use in the urgent care setting. A. Q . How do we get payors to reimburse for albuterol medications? They do not seem to pay on codes J7603 and J7609. Medicare listings for the albuterol codes have been in a state of constant flux for the past few years. You should not use J7603 and J7609, as these have been re- moved from the Medicare fee schedule in 2008. The appropriate codes are: Ⅲ J7611: concentrated albuterol (per 1 mg) Ⅲ J7612: concentrated levalbuterol (per 0.5 mg) Ⅲ J7613: unit dose albuterol (per 1 mg) Ⅲ J7614: unit dose levalbuterol (per 0.5 mg) Use each code once for each milligram that is adminis- tered. For example, if you administer 2 mg of concentrated albuterol (usually diluted with saline), then you would code J7611x2. A. Q . What is the proper coding for the administration of nebulizer treatment procedures? Typical coding for nebulizer therapy for asthma in an urgent care setting would be: Ⅲ 94640: first nebulizer treatment A. David E. Stern, MD, CPC, is a certified professional coder. He is a part- ner in Physicians Immediate Care, operating 12 urgent care centers in Oklahoma and Illinois. Stern serves on the Board of Directors of the Ur- gent Care Association of America and speaks frequently at urgent care conferences. He is CEO of Practice Velocity (www.practicevelocity.com), providing urgent care software solutions to more than 500 urgent care centers. He welcomes your questions about coding in urgent care. 40 Ⅲ 94640: each subsequent nebulizer treatment on each day Ⅲ A7003: administration set, with small volume non-fil- tered pneumatic nebulizer, disposable Ⅲ Use J7611, J7612, J7613, J7614 per the answer to the pre- vious question. Q . A national payor is clamping down on the 99051 code, claiming urgent care centers may not use this code because it is customary for urgent care centers to provide these hours of service and urgent care cen- ters are already paid more than other physician practices (which is not necessarily the case). They also said that they are looking at whether these codes were paid in error in the past, and there’s talk about reclaiming those dollars. We recently received a letter from them requesting reimbursement back to 2006 for the claims where they paid us “in error” for 99051. So there is precedent for them going back and re- questing reimbursement for claims paid in so-called “error.” My question is, what error? And do they have a le- gitimate claim to require us to refund these clams? The payor is mistaken that the code 99051 is only for hours outside of your “customary hours of service,” as the AMA defines this code as being for use during “reg- ularly scheduled office hours.” Thus, this code should never be used for services rendered other than regularly sched- uled clinic hours. In fact, there is a specific code (99050) for services ren- dered “at times other than regularly scheduled office hours.” Thus, not only is that payor mistaken, but there is another code that is appropriate to the circumstances they de- scribe. You were coding correctly. As a general rule, payors can do what they want when re- imbursing for these codes. As for take-backs, you may want to look at your contract to see if they have the right to A. JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | O c t o b e r 2 0 0 8 Continued on page 42 w w w. j u c m . c o m