Wiki Desperate for help: Drug billing

[Jacoder]

Hey everyone,

Here's a shot in the dark . . . I'm not sure if anyone will be able or willing to help me but I am in despirate need of assistance. Our hospital (facility) is currently going over our charge master making currections to HCPCS, rev codes, and descriptions. I am confused as to how we are suppose to link the dosage in our pharmacy to the dosage in the HCPCS.

Here is an example: Patient recieves Rocephin 1 gram IVPB. The nurses pull one dosage of 1 gram from the pharmacy. In the HCPCS it would be four doses of 250 mg. Do we need to break it down in the charge master so that it reflects the dosage in the HCPCS?

I'm sure we will come across more problems like this one once I get in elbow deep, so if anyone knows of a sourse where I can get help, that would be helpful as well. Thanks!

 

[drsuresh1212]

Hi ,

Even i came Across same Question while working on HCPCS level2 Coding for Drugs. see below case if helps you


NDC
Desc

00049-3437-26
FLUCONAZ D5 INJ 200MG/100ML BG

00049-3372-26
FLUCONAZ D5 INJ 200MG/100ML BO

00049-3436-26
FLUCONAZ INJ NS 400MG/200ML BG

00049-3410-30
FLUCONAZOLE TAB 50 MG

99999-P531900
FLUCONAZOLE TAB 50 MG UD

00049-3420-30
FLUCONAZOLE TAB 100 MG






Question 1) as hcpcs code J1450 desc is "Injection fluconazole, 200 mg" but if supplier desc is FLUCONAZ INJ NS 400MG than can i use J1450 code (because in code its 200MG and in suppler desc its 400MG ) ?



Question 2) can i use J1450 or J8499 code while coding FLUCONAZOLE TABLET 50 MG. (because J1450 code desc is only for Injection and supplier desc is FLUCONAZOLE TABLET 50 MG.

Answer -

1) HCPCS-J code crosswalks provide links for fluconazole 400mg to J1450 and therefore it would be acceptable to code the 400mg fluconazole products using HCPCS code J1450. Remember though that not all payers will reimburse for this HCPCS code. The NDC number must be provided on the claim.

so despite of Dose we can use Codes if mode of administration is same. ( IV and Oral will have different codes )

Hope this will help you

Thanks,

 

[Jacoder]

Dr. Suresh,

Thanks for the response. What I get from your post is: as long as the NCD number and quantity is on the claim form the HCPCS dosage doesn't have to match. Correct?