Article Detail - JA DME

Original Effective Date: 01/10/2004
Revision Effective Date: 11/01/2013

This article contains a major revision to coding guidelines provided in an article posted to the DMERC Web site in December 2003.

Effective for dates of service on or after January 1, 2004, a new code was established for combinations of albuterol sulfate and ipratropium bromide inhalation solutions:

J7621 - 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

This code may only be used when these drugs are provided in combination by a manufacturer or repackager in a vial with a single National Drug Code (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, each with its appropriate modifier – KO, KP, or KQ. For information on the correct use of these modifiers see the Nebulizers local medical review policy.

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 January 1, 2004. 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.