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New Adenosine code 'J0151'. Do we bill for discarded amount?

Kelly Posted Tue 28th of January, 2014 14:44:07 PM

Since the 'J0152' (30mg) code was deleted and now the new code is 'J0151' (1mg) do we bill for the discarded drug with a JW modifier.

In other words we did a Nuclear Stress Test on a patient and they were given 43.5 mg of Adenosine 'J0151'. Do we bill 'j0151' x44 units and then 'J0151' x16 units with JW modifier. Or, becuase they are 30mg single use vials do we just bill 'J0151' x60 units?

SuperCoder Answered Wed 29th of January, 2014 11:33:33 AM

If this is a Medicare patient, you probably can bill for the waste. Bill the wasted units on a second line, with modifier JW (Drug amount discarded/not administered to any patient). Check with your Medicare Administrative Contractor (MAC) to make sure it is processing drug waste this way, because each MAC has its own policies and procedures.

If your patient is covered by private insurance, check with the payer on its drug waste policy.

Watch the 29 mg Difference for Adenosine Units

Another noteworthy change for cardiology coders is the deletion of J0152 (Injection, adenosine for diagnostic use, 30 mg [not to be used to report any adenosine phosphate compounds; instead use A9270]).

In its place, you’ll use J0151 (Injection, adenosine for diagnostic use, 1 mg [not to be used to report any adenosine phosphate compounds, instead use A9270]).

The difference between the two codes is the number of mg per unit:
2013: J0152 was reported as 30 mg per unit
2014: J0151 is reported as 1 mg per unit.
This is a difference you can’t afford to miss. If you’re accustomed to reporting 1 unit for 6 mg adenosine, for example, and you accidentally report that 1 unit in 2014, you’ll be losing out on 5 units of reimbursement. You should report 6 units of J0151 for 6 mg adenosine.

Tip: Adenosine is sold under brand names such as Adenoscan.

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