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2012 Aridol - Mannitol Bronchial Challenge 'J7665'

SuperCoder Posted Fri 13th of January, 2012 19:35:54 PM

Does anyone know what the Medicare B LCD is for this new code? And since the J7665 = 5mg, and the kit contains (for use) up to 635mg (which cannot be saved for another patient), how do I bill for this? Maybe J7655 x 127 units?

SuperCoder Answered Sun 15th of January, 2012 18:08:09 PM

J7665 is a new code for the year 2012. You need to check really the usage is how many units of J7665 so as to decide the discarded number of units. In this context, I would suggest the use of JW modifier with the HCPCS codes with the number of units discarded to be billed in the 2nd line along with first line billing of used units.
Centers for Medicare & Medicaid Services (CMS) clarifies the appropriate use of modifier JW Discarded drug not administered when reporting unused units of drugs and biologicals for reimbursement. Failure to follow this guidance could result in excessive units billing.
Medicare reimburses physicians, hospitals, and other providers or suppliers for the unused units of a single-use vial or other single-use package as well as the dose administered up to the amount indicated on the vial or package label.

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