Primary Care Coding Alert

Question: We have a difficult time getting paid when our physician administers CR Bicillin and Rocephin to patients for tonsillitis. What is the correct way to calculate the medication?

Answer: Report J0559 (Injection, penicillin G benzathine and penicillin G procaine, 2500 units) for Bicillin CR and J0696 (Injection, ceftriaxone sodium, per 250 mg) for Rocephin by various units, depending on how many units the physician administered.

Examples: Code J0559 represents 2500 units. If you give 1.2 million units, you'll report 480 units of J0559 (1,200,000 divided by 2500 = 480). Code J0696 for Rocephin is based on 250 mg, so you need to determine how many mg your physician gives. If he gives 1 gram of Rocephin, you'll report 4 units (1 gram equals 1000 mg, so 1 gram equals 4 units of J0696). If the patient receives either medication because of tonsillitis, submit diagnosis 463 (Acute tonsillitis).