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Patricia Posted Sun 21st of August, 2011 21:02:33 PM

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

THANKS FOR YOUR HELP, AS ALWAYS.
PATRICIA

SuperCoder Answered Mon 22nd of August, 2011 13:49:15 PM

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

Patricia Posted Tue 23rd of August, 2011 23:25:12 PM

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

SuperCoder Answered Wed 24th of August, 2011 05:32:17 AM

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.

SuperCoder Answered Wed 24th of August, 2011 15:38:28 PM

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 “at 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.

Patricia Posted Wed 24th of August, 2011 18:32:49 PM

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

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