Billing drugs when less then stated quantity given

LisaBadie

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How would you bill for a drug when the amount administered is less than the amount stated in the HCPCS. Example J2430 is per 30 mg. If provider administers 15 mg, how would you bill for this? The remainder is not considered wastage.
 

ciphermed

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To my knowledge you would bill for one unit as units are reported in whole numbers...you cannot report 1/2 a unit on a claim.

If the dosage given exceeds the per unit dose (hcpcs descriptor) you would round up...

For ex. descriptor indicates per 30 mg....If 40mg were given you'd bill 2 units
(1 unit for the 1st 30 mg, the 2nd unit to capture the add'l 10 mg)

I do not have a reference at this time, however I believe CMS has addressed it.

Hope this helps,
 

ciphermed

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References...
“When the dosage amount is greater than the amount indicated for the HCPCS code,
the facility rounds up to determine units. When the dosage amount is less than the
amount indicated for the HCPCS code, use 1 as the unit of measure.”

http://www.cms.hhs.gov/Transmittals/Downloads/R903CP.pdf


Correct Reporting of Units for Drugs
Hospitals and providers are reminded to ensure that units of drugs administered to patients are accurately reported in terms of the dosage specified in the full HCPCS code descriptor. That is, units should be reported in multiples of the units included in the HCPCS descriptor. For example, if the description for the drug code is 50 mg, but 200 mg of the drug was administered to the patient, the units billed should be 4. Providers and hospitals should not bill the units based on the way the drug is packaged, stored, or stocked. That is, if the HCPCS descriptor for the drug code specifies 1 mg, and a 10 mg vial of the drug was administered to the patient, bill 10 units, even though only 1 vial was administered. HCPCS short descriptors are limited to 28 characters, which includes spaces, so short descriptors do not always capture the complete description of the drug. Therefore, before submitting Medicare claims for drugs and biologicals, it is extremely important to review the complete long descriptors for the applicable HCPCS codes.
The full descriptors for the Level II HCPCS codes can be found in the latest code books or from the latest Level II HCPCS file, which is available for downloading from the CMS Web site at: http://www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp#TopOfPage.
Providers are reminded to check HCPCS descriptors for any changes to the units when HCPCS definitions or codes are changed.
http://www.cms.hhs.gov/transmittals/Downloads/R1060CP.pdf
 
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