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J2175 Demerol

Tammy Posted Wed 19th of June, 2013 18:14:28 PM

The J2175 is for 100mg. Patient only received .50mg what code would we use?
or how do we bill?
thank you!!

SuperCoder Answered Fri 21st of June, 2013 12:23:35 PM

Check to see whether your payer has a stated policy.

Generally speaking, you use the drug-specific code with 1 unit if the amount administered is under the amount listed in the code, and follow payer guidelines about including the amount administered and the amount being charged. For instance, Medicare Claims Processing Manual, Chapter 17, Section 10, says, “If the full dosage provided is less than the dosage for the HCPCS code descriptor specifying the minimum dosage for the drug, the provider reports one unit of the HCPCS code for the minimum dosage amount.” http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c17.pdf

Some payers may have more specific rules. E.g., see this NHIC document which changes coding based on vial size: http://www.medicarenhic.com/providers/articles/CodingDrugsBios.pdf

It states, “For example, a 25 mg injection of Demerol is administered from a 25 mg vial. There is currently no HCPCS code for a 25 mg vial of Demerol. It would be appropriate to use J3490 in this instance. The only HCPCS code available for Demerol is J2175; for a 100 mg vial. If a 25mg injection of Demerol is administered from a 100 mg vial, then J2175 should be used with waste reported and documented in the medical record.”

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