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Billing units for single vial given over multiple DOS

alannae

Networker
Messages
90
Best answers
0
I bill for a physician practice/office. We are having a discussion about how to most appropriately and ethically bill this situation. I appreciate anyone's opinions.

Patient is receiving 18mg of Cytarabine on Monday, Wednesday and Friday. Cytarabine (J9100) comes in a 100mg single-dose vial but is reconstituted to be viable for several days (a single vial is used to give all three 18mg doses for the week). The code J9100 is for 100mg of Cytarabine. There is no other code for this drug. (I have verified with the medical staff that it is not Cytarabine Liposome).

We are trying to decide if we should bill J9100 x1 for each DOS or if we should somehow indicate that only 100mg total is being used.

Thoughts?

Alanna Esler, CPC
 

lpetrova

Networker
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31
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0
How about billing for the entire vial (100 mg) on Day 1, and on Day 2 and 3 billing only for the administration in conjunction with J9100 showing $0.00?

We have done this a couple of years ago d/t the drug shortage. All the claims would indicate that there is a supportive documentation on file. Calling the carrier and discussing the game plan prior to claim submission might not be a bad idea. We might have done it but I don't remember for certain -
 

alannae

Networker
Messages
90
Best answers
0
That is one of the options we've discussed (although our software requires that we must bill $0.01 instead of $0.00).

The payer is Medicare (Novitas). I keep reading and rereading the section on waste and splitting vials on their LCA (https://www.novitas-solutions.com/articles/jh/a52018.html) but it doesn't really address this situation.

I guess I will reach out to them...

Thanks!
 
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