Marlene Posted Fri 22nd of April, 2016 10:40:49 AM
My question is regarding billing for Pain Ball Pumps used after surgery for pain control. We are a facility/hospital. The Ropivacaine 0.2% x 1500 units is bein billed all on the same date of service for the pain ball compound with J2795. I am wondering if per our Pharmacist we should be billing these with the J7799 code for Compound drugs as it is thru a pain ball? There is Medically Unlikely Edits that you cannot bill the J2795 greater than 200 units per day. That is why I am thinking we should be billing a Compound Drug J7799 HCPCS code. Please Advise...Thxs
SuperCoder Answered Mon 25th of April, 2016 08:16:55 AM
Yes you can use HCPCS code J7799 for the compound drug.
Compounded medications are created by a pharmacist in accordance with the Federal Food, Drug and Cosmetic Act and may be covered under Medicare when their use meets all other criteria for services incident to a physician’s service.
Compounded medications do not have a National Drug Code (NDC) number, an average sales price (ASP) or an average wholesale price (AWP). Accordingly, the specific HCPCS J codes for the drugs in the compounded formulation may not be submitted. Instead, providers must use HCPCS code J7799 (unclassified drug) for reimbursement of the compound.
The use of compounded drugs has been especially prevalent in the filling of implantable infusion pumps. Whether a single agent or a combination of agents is used, the compounded medication must be submitted with HCPCS code J7799 even though the compound is similar to or includes a drug with a specific HCPCS code (e.g., HCPCS code J2275 for preservative free morphine).