Marina Posted Thu 04th of February, 2016 14:08:10 PM
I am looking for procedure code to bill to Medicare for 5FU. Also, how much should I charge for the medication?
SuperCoder Answered Fri 05th of February, 2016 02:09:07 AM
The appropriate code and the charge depends on the exact scenario, so to answer this, I will need to have the case details.
However, for example if the eye surgeon administers a planned subconjunctival injection of 5-FU in his office, 68200 (subconjunctival injection) is the appropriate CPT code to describe the 5-FU injection, and you append modifier -58 to indicate a staged procedure.
Additionally, use J9190 (Fluorouracil, 500 mg) to report the supply of medication. These codes cover the cost of the drug only, and do not include the administration.
Bill local carrier if incident to a Physician's service or used in an implanted infusion pump. If other, bill DME/MAC.
I hope this helps, however, if you need to know the exact information, then please send me the case details. Thanks!!