Oncology & Hematology Coding Alert

Question: What is the correct way to bill multidose vial drug amounts on a HCFA-1500? If a code has a billing unit of 500 mg and is a multidose vial, but you only use 375 mg, what goes into the unit column? Should you recalculate your fee based on the lower dose?

Pennsylvania Subscriber

Answer: When using a drug from a multiple-dose vial, the billing does not depend on the vial size but on the quantity administered. You should use the HCPCS J-codes to describe the quantity administered.

Some drugs have multiple J-codes for different quantities. For example, J9070 is for 100 mg of cyclophosphamide, and J9080 is used for 200 mg of cyclophosphamide. If the dosage administered can be accurately described through a combination of codes, then multiple codes should be used. To illustrate, if a patient receives 300 mg of cyclophosphamide, indicate one unit of J9070 and one unit of J9080.

In this case, the HCFA 1500 should include the following information:

Date of Service 09/01/00
HCPCS code J9070
Billing unit 100 mg
Description Cyclophosphamide
Units 1

Date of Service 09/01/00
HCPCS code J9080
Billing unit 200 mg
Description Cyclophosphamide
Units 1

If the quantity administered from a multiple-dose vial falls between multiples of the J-code amount, most oncologists would round up to avoid out-of-pocket losses.
For example, the J-code quantity for floxuridine (J9200) is 500 mg. If you administer 375 mg, round up and report one unit (assuming that no other patient received any of the remaining dose).

Using this example, the HCFA-1500 should contain the following information:

Date of Service 09/01/00
HCPCS code J9200
Billing unit 500 mg
Description Floxuridine
Units 1