Quantity Counts — Make Sure You Bill Accurate Amounts
By Melissa Brown, CPC, CPC-I, CFPC — Jacksonville, FL
As codes change for 2011 next week, make sure you actively look for changes related to quantities in the codes. HCPCS Level II drug codes are particularly ripe for error if you aren’t checking carefully. Some simple checks will help improve billing for quantity-based codes.
Check the Math and Look for Coding Changes
To assign HCPCS Level II codes, calculate units billed from how the drug is supplied and the amount given to the patient. Recognize that the dosage unit administered or listed on the package doesn’t always match the billing unit.
Here’s an example: A total of 500 mg of tetracycline is given to a patient. The code is J0120 Injection, tetracycline, up to 250 mg. To capture the full payment for the drug administered, J0120 should be billed with 2 units.
The conversions aren’t always straightforward. Consider the patient to whom two 2 mL syringes containing 1,200,000 units each of Bicillin C-R are administered. The code for this is J0559 Injection, penicillin G benzathine and penicillin G procaine, 2500 units. The biller converting this information must make two calculations — one for the two vials and one to convert the vials to units.
The total amount injected is 2,400,000 units (1,200,000 X 2). Next the number of units administered must be converted to billing units. The billing unit in this example is 2500; therefore, the bill should reflect J0559 with 960 units (2,400,000/2,500 = 960). As of January 1, 2011, this example changes again since J0559 has been deleted and replaced with J0558 Injection, penicillin G benzathine and penicillin G procaine, 100,000 units making the units to bill for the same injection only 24 (2,400,000/100,000=24). This is a prime example of why you need to check for coding changes.
Know What You’re Reporting and Where
Remember to report the National Drug Code (NDC) and units on the claim. The unit number with the package (and its NDC) doesn’t always match the billing unit. In our example, the billing unit was 2500. The medication was provided in 2 mL syringes, so the NDC units would be reported as ML4 since each syringe contained 2 mL.
Don’t Eat the Waste
Leftover units not administered from the drug’s package are referred to as waste. Rather than eating the cost of the waste units, report them on a separate line with modifier JW Drug or biological amount discarded/not administered to any patient. You may be able to recoup the cost of the drug that can’t be used on other patients. Make sure details relating to the amount given and cause for the waste amount are well documented.
Why Math Matters
You can see why it’s important to capture every opportunity to recoup the cost of drugs and biologicals. It’s equally important to check the changes to assure you aren’t inadvertently overbilling either. Mistakes that over-report the units raise red flags and put a practice at risk for charges of fraud. Taking time to understand how to account for and report billing units and NDC units is crucial in making sure you get every penny due.