Basic Guidelines for Billing Nebulizers

1. Basic Guidelines for Billing Nebulizers Medical Billers and Coders

2. Nebulizers can be covered if the member’s ability to breathe is severely impaired. Lung diseases such as chronic obstructive pulmonary disease (COPD) and asthma are characterized by airflow limitation that may be partially or completely reversible. Pharmacologic treatment with bronchodilators is used to prevent and/or control daily symptoms that may cause disability for persons with these diseases. These medications are intended to improve the movement of air into and from the lungs by relaxing and dilating the bronchial passageways. Beta-adrenergic agonists are a commonly prescribed class of bronchodilator drugs. They can be administered via nebulizer, metered-dose inhaler, orally, or dry powdered inhaler.

3. CMS Need Nebulizer Necessity Nebulizers require an in-person or face-to-face interaction between the beneficiary and their treating physician prior to prescribing the item, specifically to document that the beneficiary was evaluated and/or treated for a condition that supports the need for the item(s) of DME ordered. A dispensing order is not sufficient to provide these items.

4. 5-element order (5EO) WOPD (written order prior to delivery) is required and must include the following elements: • Beneficiary’s name • Item of DME ordered. this may be general (for example, hospital bed) or more specific (for example, continuous glucose monitor [CGM]) • Signature of the prescribing practitioner • Prescribing practitioner’s National Provider Identifier (NPI) • The date of the order • A completed 5EO within 6 months after the required Affordable Care Act (ACA) 6407 face-to-face examination • The supplier’s receipt of the 5EO before delivery of the listed item(s) • A date stamp or equivalent must be used to document the 5EO receipt date

5. Appropriate documentation for Nebulizers must include the following items: A recent order by the treating physician for refills, A recent change in prescription, and Beneficiary’s medical record within 12 months of the date of service showing usage of the item

6. When a shipping service makes a delivery, the following documentation elements must be present: • Beneficiary’s name • Delivery address • Delivery service’s package identification number, supplier invoice number, or alternative method that links the supplier’s delivery documents with the delivery service’s records • A description of the items being delivered. The description can be either a narrative description (for example, a lightweight wheelchair base), and HCPCS Level II code, the long description of an HCPCS Level II code, or a brand name/model number • Quantity delivered • Date delivered • Evidence of delivery

7. When you are ordering nebulizers and the drugs used in them for your patients, documentation plays a crucial role. Choosing the right CPT also ensures timely reimbursement without denials. Medical billing for Nebulizers is a time-consuming activity that requires constant follow-ups in case of denials. Medical Billers and Coders (MBC) can help you to reduce documentation burden as well as can assist you in increasing your revenue by addressing denials promptly.

8. Get in Touch Medical Billers and Coders Email : info@medicalbillersandcoders.com Toll Free no: 888-357-3226