How do you bill for Bupivicane?

KnappTC

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My ASC bills for the use of Buvipicane or Esparel 1.3% (C9290). We purchase it in bottles of 20ml (one use). How many units do I bill this as. Medicare shows 1 unit as 1 mg? I dont know hoe to convert this. Thanks
 

EdTownley

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Exparek / bupivacaine liposome [C9290]

I found this on the website for Exparel:

EXPAREL (bupivacaine liposome injectable suspension) is available in single-use vials for infiltration. 20 mL single use vial, 1.3% (13.3 mg/mL) packaged in cartons of 10 (NDC 65250-266-20)

Different formulations of bupivacaine are not bioequivalent even if the milligram strength is the same. Therefore, it is not possible to convert dosing from any other formulations of bupivacaine to EXPAREL.


13.3 mg/mL x 20 mL in the SDV would then be a total of 266 mg (if the total vial is used).

Coding would then be the HCPCS code C9290 - Injection, bupivacaine liposome, 1 mg x266 units. If less than the total vial is used, of course, you would apply the same conversion factor of 13.3 mg/mL to the number of mL administered.

This same may not apply to other formulations of the drug, based on the comment in the package insert found on the website www.exparel.com. Depending on the payor you may have to report waste on the claim.

Ed Townley, CPC, CPC-i, Certified ICD-10 Instructor, ROCC
 
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WE BILLED EXPAREL FOR C9290 RT = 266.0 UNITS = $400.00 AND TO THE C9290 LT 266 mg/20 mL Single-dose viaL USING ALL OF IT ON EACH SIDE WITH 27446 RT, 27446 - LT AND 27438 RT AND 27438 LT. BOTH C9290 WERE DENIED. CO-151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services. WHAT CAN I DO FOR MEDICARE TO PROCESS FOR PAYMENT C9290 WERE USED ON BOTH SIDES... LT
 

SharonCollachi

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WE BILLED EXPAREL FOR C9290 RT = 266.0 UNITS = $400.00 AND TO THE C9290 LT 266 mg/20 mL Single-dose viaL USING ALL OF IT ON EACH SIDE WITH 27446 RT, 27446 - LT AND 27438 RT AND 27438 LT. BOTH C9290 WERE DENIED. CO-151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services. WHAT CAN I DO FOR MEDICARE TO PROCESS FOR PAYMENT C9290 WERE USED ON BOTH SIDES... LT
Appeal with your documentation of procedure performed.
 
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