|
25.3.3.4 Aerosol Treatment
Aerosol treatments, including vaporizers, humidifiers, nebulizers, and inhalers are a benefit of the Texas Medicaid Program. These treatments must be coded with revenue code B-412, Respiratory services-inhalation services.
The following diagnosis codes are payable for aerosol treatments:
Medications used in aerosol therapy are reimbursed separately and must be billed using the appropriate HCPCS procedure code. Saline used in aerosol therapy is denied as part of the aerosol therapy.
Revenue code B-412, Inhalation services, billed for aerosol therapy in the recovery room after outpatient surgery (billed on an outpatient claim) is also allowable as it is a necessary adjunct to the postoperative recovery of a client who has undergone general anesthesia.
Revenue code B-412 includes the inhalers listed below and is payable in the outpatient setting (place of service [POS] 5) when it is the only therapy billed on that day:
• Beclomethasone dipropionate (Vanceril or Beclovent oral inhalers).
•Isoproterenol sulfate (Iso-Autohaler, Luf-Iso Inhaler, Medihaler-Iso, Norisodrine Aerohaler).
•Isoproterenol hydrochloride (Iprenol, Vapo-Iso inhalers).
•Albuterol (Proventil or Ventolin inhalers).
•Metaproterenol sulfate (Alupent Metered Dose inhaler, Metaprel inhaler, Alupent 10 mL, Alupent 30 mL).
•Epinephrine bitartrate (Medihaler-Epi and Primatene Mist Suspension inhaler).
•Phenylephrine bitartrate (Duo-Medihaler).
•Isoetharine mesylate inhalation aerosol (Bronkometer).
•Dexamethasone sodium phosphate (Turbinaire or Respihaler).
When revenue code B-412, Respiratory services-inhalation services, is billed on the same day for both aerosol therapy and inhalers, only one service is allowed, not both.
Pulse oximetry is considered part of an evaluation and management visit and will not be reimbursed separately. Demonstration and/or evaluation of client utilization of an aerosol generator, nebulizer, metered dose inhaler, or intermittent positive pressure breathing (IPPB) device will not be reimbursed separately.
IPPB treatments have been determined to be inappropriate for the treatment of most respiratory problems and are denied.
|
