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Units for Cyramza

Loni Posted Tue 02nd of December, 2014 13:21:07 PM

When billing an antineoplastic (such as Cyramza) with no HCPCS assigned yet, we are using J9999. Please advise how to select the proper units to bill.

If the single-dose vial is 100mg/10mL and a patient receives 863.2mg and 36.8mg are wasted, what is the correct number of units to bill?

Is correct coding to indicate 1 unit and list dosage in the miscellaneous text since we use J9999, or if we list the amount given, as in 900mg, is that improper coding/billing?

Loni Posted Thu 04th of December, 2014 12:54:29 PM

I haven't received an answer yet, which is unusual. Please see above.

SuperCoder Answered Fri 05th of December, 2014 03:49:41 AM

Hi,
Medicare has not given any dosage unit to this unlisted code.
To know more, please see example below:
Example: One billing unit for a drug is equal to 10mg of the drug in a single use vial. A 8mg dose is administered to a patient while 2mg of the remaining drug is discarded. The 8mg dose is billed using one billing unit that represents 10mg on a single line item. The single line item of 1 unit would be processed for payment of the total 10mg of drug (administered and discarded).

When submitting an unlisted or non-specific J-code (e.g., J3490, J8499, J9999), always enter one unit in Field 24-G and indicate the dosage of the drug (eg.863.2mg in your case) on the HCFA-1500 form in Field 24-D under the J-code. The National Drug Code (NDC) is always helpful on unlisted J-code, if one is available. If the drug is a "compound drug", please indicate "compound drug" in Field 24-D.
Thanks.

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