depot lupron

LDH CPC CPMA

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I have dr's that go to out of town clinics that are hospitals. They give depot lupron injections there. We billed out as place of service as outpt hospital.Medicare denied our claim due to place of service should we bill office instead of out pt hospital?


Thank you:confused:

Sorry , we take the drugs with us to the out of town clinics. the code is J9217 and we usually use 3 or 4 units because the pts are usually getting it for 3 or 4 months.
 
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alhmed

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what is been denied by medicare? the drug , the administration , both? any payer will reimburse the drug as opt if the physician expenses are involved. question is who paid for the drug? usually opt drugs administered in the hosp are hosp expenses and the physicain can bill only for the administration. if the phyisician provided the med then you should bill pos 11 since this is the office expenses.
 

reddel

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Lupron

Was it J9217 or J9218? I'm pretty sure they are the same drug, just difference in billing units and I think insurance (particulary Medicare) is funny about paying for on over the other. We bill J9217 in the office which is one 7.5 mg of lupron.
 
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