Anesthesia Coding Alert

Question: What is the correct way to bill medication units during pump refills, such as J0735 (Injection, clonidine HCl, 1 mg)?

Wyoming Subscriber

Answer: Your first step is verifying whether the medication is compounded rather than a commercially prepared "off-the-shelf" preparation such as Duraclon, which comes in two strengths (0.1 mg/ml or 0.5 mg/ml).

Example: If your provider fills the pump with 40 mg of commercially-prepared Duraclon, you would bill for either 400 ml of the 0.1 mg/ml strength or 80 ml of the 0.5 mg/ml strength. Because most implanted infusion pumps hold 20 to 40 ml, it's likely that the clonidine is being compounded at a specially made concentration so the patient can receive the correct quantity of medication for the limited pump volume.

Compound change: Many Medicare contractors have policies regarding how they want you to report compounded drugs, especially those used in implanted infusion pumps. Many request either J3490 (Unclassified drugs) or J7799 (NOC drugs, other than inhalation drugs, administered through DME) rather than a code for commercially-prepared drugs such as J7035.

Last check: Some payers require the physician to use a payer-designated specialty pharmacy to compound the patient-specific prescription. The pharmacy invoices the insurance directly and the physician incurs no out-ofpocket expense for the compound. If that's the case, you'll report only the applicable service codes such as 62368 (Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion [includes evaluation of reservoir status, alarm status, drug prescription status]; with reprogramming) and 95991 (Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal [intrathecal, epidural] or brain [intraventricular]; administered by physician).