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  1. User id : 17957 Posted 3 years ago

    HOW ARE YOU BILLING FOR THE ABOVE MEDS, AND WHICH CODES ARE BEING USED?

    THANKS FOR YOUR HELP, AS ALWAYS.
    PATRICIA

  2. SuperCoder Posted 3 years ago

    Can you please check out the spelling, and also if you have any info of the reason for which this drug is injected?

  3. User id : 17957 Posted 3 years ago

    Yes I copied the doctors note, sorry. It is Rocephin.

    Also to add to this question how do you bill for a demo of an inhaler?

    Thanks again,
    Patricia

  4. SuperCoder Posted 3 years ago

    I hope you could bill HCPCS Level II code J0696 for Rocephin, but there is no fee value assigned for this code. RVU is 0 in (MPFSDB) and for demo inhaler, you could use CPT level I code 94664.

  5. SuperCoder Posted 3 years ago

    Answer: For Rocephin, use code J0696:
    The HCPCS Level II code and definition of Rocephin is J0696 – per 250 mgs. This 250 mg dose is usually given to a child. An adult may be given one gram of Rocephin. The billing for this injection should be J0696 – 4 units (or 250 mgs x 4).

    Attention must be given to the code definition of dosaging, in order to ensure that the correct units/price is billed to the insurance company.

    Example:
    Rocephin comes in a 1gm vial. This vial is a "single" dose. So, even if you just give the pt 500mg, you have to discard the remainder. This is why you bill for the full 1gm. So, you would use the code J0696 with 4 units, which is equal to 1000 mg, but make sure that you are using the correct NDC per vial

    For administration, we can use: 96372 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

    https://www.dmepdac.com/docs/crosswalk/august_11/2011-08-05_xwalkfinalversion.pdf

    Note for Reimbursement: Indicate that the Rocephin payment needs to include the purchase price, and dollars for the office expenses noted. For vaccine reimbursement (which you can correlate to medication payment), the price should be β€œat least 17-28 percent above the vaccine purchase price,” according to The Business Case for Pricing New Vaccines by the AAP Private- Sector Advocacy Advisory Committee. If the administration reimbursement is less than appropriate, you should renegotiate this fee.

  6. User id : 17957 Posted 3 years ago

    Thank you so much for this is a great help. Most people are saying not to bill the J0696 just the Adm code for insuarnce is not paying. What is your take on this?

    Thanks again for your help.
    Patricia

About this Question

  • Posted by 17957, 3 years ago. There are 6 posts. The latest reply is from 17957.