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    Clinician Checklist Nebulizers

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    Doha El-shafȝi
    The clinician checklist for nebulizers requires the clinician to complete a standard written order and ensure appropriate medical records are documented when ordering certain drugs and equipment for pulmonary conditions. This includes documenting that the drug is reasonable and necessary for specific diagnoses for conditions like cystic fibrosis, HIV, or pulmonary hypertension. Large volume nebulizers also require documentation that humidity is needed for thick secretions.

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    Clinician Checklist Nebulizers

    Uploaded by

    Doha El-shafȝi
    33 views2 pages
    The clinician checklist for nebulizers requires the clinician to complete a standard written order and ensure appropriate medical records are documented when ordering certain drugs and equipment for pulmonary conditions. This includes documenting that the drug is reasonable and necessary for specific diagnoses for conditions like cystic fibrosis, HIV, or pulmonary hypertension. Large volume nebulizers also require documentation that humidity is needed for thick secretions.

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    Clinician Checklist Nebulizers (1)

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    The clinician checklist for nebulizers requires the clinician to complete a standard written order and ensure appropriate medical records are documented when ordering certain drugs and equipment for pulmonary conditions. This includes documenting that the drug is reasonable and necessary for specific diagnoses for conditions like cystic fibrosis, HIV, or pulmonary hypertension. Large volume nebulizers also require documentation that humidity is needed for thick secretions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    33 views2 pages

    Clinician Checklist Nebulizers

    Uploaded by

    Doha El-shafȝi
    The clinician checklist for nebulizers requires the clinician to complete a standard written order and ensure appropriate medical records are documented when ordering certain drugs and equipment for pulmonary conditions. This includes documenting that the drug is reasonable and necessary for specific diagnoses for conditions like cystic fibrosis, HIV, or pulmonary hypertension. Large volume nebulizers also require documentation that humidity is needed for thick secretions.

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    © All Rights Reserved
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    of 2

    CLINICIAN CHECKLIST FOR NEBULIZERS

    Policy References:
    § Local Coverage Determination (LCD) (L33370)
    § Policy Article (A52466)
    Documentation References: Standard Documentation Requirements Policy Article (A55426)
    The treating clinician must complete the following items:
    Standard Written Order (SWO)
    Medical records as noted below
    Medical Documentation

    Small Volume Nebulizers, Related Compressor, and FDA-Approved


    Inhalation Drugs
    It is reasonable and necessary to administer albuterol (J7611, J7613), arformoterol (J7605),
    budesonide (J7626), cromolyn (J7631), formoterol (J7606), ipratropium (J7644), levalbuterol
    (J7612, J7614), metaproterenol (J7669), or revefenacin (J7677) for the management of
    obstructive pulmonary disease (refer to the Group 8 Codes in the LCD-related Policy Article
    for applicable diagnoses); or
    It is reasonable and necessary to administer dornase alfa (J7639) to a beneficiary with cystic
    fibrosis (refer to the Group 9 Codes in the LCD-related Policy Article for applicable
    diagnoses); or
    It is reasonable and necessary to administer tobramycin (J7682) to a beneficiary with cystic
    fibrosis or bronchiectasis (refer to the Group 10 Codes in the LCD-related Policy Article for
    applicable diagnoses); or
    It is reasonable and necessary to administer pentamidine (J2545) to a beneficiary with HIV,
    pneumocystosis, or complications of organ transplants (refer to the Group 4 Codes in the
    LCD-related Policy Article for applicable diagnoses); or
    It is reasonable and necessary to administer acetylcysteine (J7608) for persistent thick or
    tenacious pulmonary secretions (refer to the Group 7 Codes in the LCD-related Policy Article
    for applicable diagnoses).

    Large Volume Nebulizer, Related Compressor, and Water or Saline

    Clinician Checklist for Nebulizers Last Updated 12/11/2021


    1
    When reasonable and necessary to deliver required humidity for thick, tenacious secretions
    to beneficiaries with cystic fibrosis, bronchiectasis, tracheostomy, or tracheobronchial stents
    (refer to the Group 5 Codes in the LCD-related Policy Article for applicable diagnoses).

    Filtered Nebulizer and Compressor


    When reasonable and necessary to administer pentamidine to beneficiaries with HIV,
    pneumocystosis, or complications of organ transplants (refer to the Group 1 Codes in the
    LCD-related Policy Article for applicable diagnoses).

    Small Volume Ultrasonic Nebulizer or Controlled Dose Inhalation Drug


    Delivery System
    When reasonable and necessary to administer treprostinil inhalation solution only.

    Treprostinil Inhalation Solution (J7686) and Iloprost (Q4074)


    Criteria 1 - 3 are met:
    1. Beneficiary has a diagnosis of pulmonary artery hypertension (refer to the Group 11 Codes
    in the LCD-related Policy Article for applicable diagnoses); and
    2. Pulmonary hypertension is not secondary to pulmonary venous hypertension (e.g., left
    sided atrial or ventricular disease, left sided valvular heart disease, etc.) or disorders of the
    respiratory system (e.g., chronic obstructive pulmonary disease, interstitial lung disease,
    obstructive sleep apnea or other sleep disordered breathing, alveolar hypoventilation
    disorders, etc.); and
    3. Beneficiary has primary pulmonary hypertension or pulmonary hypertension which is
    secondary to one of the following conditions: connective tissue disease, thromboembolic
    disease of the pulmonary arteries, human immunodeficiency virus (HIV) infection, cirrhosis,
    anorexigens or congenital left to right shunts. If these conditions are present, the following
    criteria (a-d) must be met:
    a. Pulmonary hypertension has progressed despite maximal medical and/or surgical
    treatment of the identified condition; and
    b. Mean pulmonary artery pressure is > 25 mm Hg at rest or > 30 mm Hg with exertion;
    and
    c. Beneficiary has significant symptoms from the pulmonary hypertension (i.e., severe
    dyspnea on exertion, and either fatigability, angina, or syncope); and
    d. Treatment with oral calcium channel blocking agents has been tried and failed or has
    been considered and ruled out.

    Clinician Checklist for Nebulizers Last Updated 12/11/2021


    2

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