Wiki J codes for interthecal pump refills

[skweston]

Hi I am new to pain managment billing/coding. The dr I work for has a patient with pain pump (interthecal) and my question is how do you figure out the proper units to bill

Example J3010 .1mg how do u convert from micrograms to milligrams?

I know that just 1 unit is only paid .70 by Medicare. The doctor pays for the meds out of pocket (100.00). I guess what I would like to know if there is anyone else in the State of Florida that works in Pain Management that could assist with the proper billing of this J code? According to the Florida Medicare MAC I just have to indicate how many units of the drug were used to get paid and no need to send them copy of invoice stating amount paid by the doctor.

Any help or send me in right direction. I am getting frustrated

 

[dwaldman]

https://www.cahabagba.com/part_b/claims/fee_schedules/2011_pump_drugs_jan.htm

I saw this link that corresponds with .70

50 micrograms per ML which is the same as .05 miligrams

.1 mg equals 100 micrograms


http://www.medicineonline.com/drugs/f/2970/FENTANYL-CITRATE-InjectionUSP.html

DOSAGE AND ADMINISTRATION
50 mcg = 0.05 mg = 1 mL

http://www.buyemp.com/product/1124108.html

Fentanyl Citrate 0.05 mg 5mL Vial- DEA Class II item # item description U of M price quantity

0409-9094-25 FENTANYL CITRATE 0.05 MG/ML 5ML FTV, 25/BX, C-II Box $58.98

Below link is a convertor from micrograms to milligrams

http://www.unitconversion.org/weight/micrograms-to-milligrams-conversion.html

So my understanding if you for example provided .4 milligrams or 400 micrograms
you would bill J3010 x 4 units---From searching the internet of costs and packaging the 100.00 you are mentioning can not be the cost of what is being placed in the pump. Not sure if that is what you are suggesting.

 

[skweston]

Thank you so much... I will show this post to the Doctor. I know that he paid $100 for the medication from the pharmacy, he has the invoice. However it seems as though that he will not get reimbursed any where near the amount he paid for the meds? I know he will not be pleased to hear this, however do you have any suggestions for him when billing for the meds he refills his patients pumps with so that he can get reimbursed for his out of pocket expenses if that is even possible? Seems like he needs to find a different supplier (pharmacy). Any insight into this would be greatly appreciated. Being new in the field and the only one in the office I don't have any networking connections yet to assist me.

 

[mitchellde]

You may need the NDC number for one thing. Otherwise if this is really the offset between cost and reimbursement you may need to have the patient obtain the drug from the pharmacy and bring it to your office. But I have seen many drug issues resolve with using the correct NDC number. You need the N4 qualifier first and the NDC number after.

 

[marvelh]

Answers to find out...
Was Fentanyl the only drug that was used to refill the implanted pump?

Was the pump refill compounded by a compounding pharmacist or was the drug purchased from a pharmaceutical supply company that sells only the commercially available concentration?

If it was compounded, you will not bill it with J3010 to First Coast for Medicare, but rather J3490 with the KD modifier. In addition, you will need to send the following information in box 19 or the electronic equivalent field:
• Name(s) and dose (s) of drug(s) administered into the implantable pump
• Volume of refill in ml
• Pump reservoir size (ml)
• Exact invoice price for that individual patient claim for infusion drugs furnished via implanted DME, with dates of service on or after January 1, 2004, shall be identified using the modifier KD. Units billed should be (1) in the days/units field (Item 24G) on CMS 1500 claim form
Here is a link for this information: http://medicare.fcso.com/Coverage_News/164199.asp

If the fentanyl was commercially prepared, though pretty unlikely, it would have it's own valid NDC number and you would need to know the total amount of Fentanyl that was used for the refill. This can also be calculated but you would need to know the strength of the fentanyl and volume that as injected. For example, if the Fentanyl was 0.5 mg (50 mcg) per ml (strength) and a total of 20 ml was injected (common implanted pump volume) a full refill would be 20 x 0.5 or 10 mg. In this example if you were billing the commercially prepared Fentanyl and not a compounded version, you would bill need to bill 100 units of J3010 (10 x 0.1)

My bet though is that Fentanyl is not the only drug in the refill and/or it is a compounded preparation specially created just for that patient by a compounding pharmacist, which would be reported with the J3490 code rather than the J3010 code.