Oncology & Hematology Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: We purchase Ativan (J2060) in 20-mg multi-use vials. The billing unit is 2 mg, which means 10 people should be billable from this vial. Our doctors contend the standard dose of Ativan is 0.5 mg, which means we can get 40 doses out of the vial. Should we bill one unit and waste 1.5 mg per patient, or use J3490 to indicate that 0.5 mg of the standard 2-mg dosage was given?
       
California Subscriber


    Answer: Medicare guidelines state that if the dosage was less than that listed in HCPCS, the larger unit should be billed.
 
But you also have to look at the intention of the guideline. Medicare guidelines for multi-use vials were implemented to prevent practices from having to absorb the cost of drugs wasted because the dose amount does not equal the vial amount. In some cases, this could lead practices to lose money because they cannot recoup the cost of the vial when too much is wasted.
 
The first option calls for wasting 15 mg per vial. This is not recommended because the practice will waste three-quarters of the vial without being paid.
 
The other option mentioned is to bill each 0.5 mg as one unit. In other words, report J2060 and get paid for a 2-mg dose. This is in compliance with Medicare, but while guidelines may open the door for this sort of practice, it can be argued that this was not the intention.
 
Using J3490 (unclassified drugs) is the safest option. Along with J3490, you should use the comment box on the claim form to include the name of the drug with J2060, the drug's National Drug Code number, and that 0.5 mg was used rather than the standard 2 mg.
 
Note: J2060 should be included in the comment box, not in the box used to list CPT and HCPCS codes.
  
The carrier might change the code back to J2060 to fall in line with Medicare guidelines. If so, the practice can rest assured that it cannot be cited for trying to garner undeserved payment.