Wiki J0559- does anyone know WHY this changed?

[angelenaanold13]

I am having an issue having J0559 for Bicillan CR added into our system. I need to fight my arguement, even though it is in black and white in the HCPCS book of the change. Does anyone know why it got changed for 2010 to 2500 units instead of 600,000 or 1,200,000? Also- do I charge a 1.2M out as J0559 X 480 units?

Thanks in advance!

 

[janny]

CMS's J0559 explanation

I found this at http://www.cms.gov/prit/pritia/itemdetail.asp?itemid=CMS1233104:

"February 12: The HCPCS Level II code set are maintained by CMS. The HCPCS code set included three codes (J0530, J0540 and J0550) all for the same drug (Pen G Benzathine and Pen G Procaine). The codes were differentiated only by the dose amount. All three codes were discontinued effective 12/31/2009 and replaced with a single, new code J0559 (effective 1/1/2010) which identifies the same drug and specifies a dose of 2500 units. This is consistent with CMS' policy to use a dose amount in drug codes that represents the "lowest common denominator" as a unit that can be reported in multiples in the "units" column on a claim form - to report the actual amount administered. It is not unusual for the number of units reported to be in the hundreds. As long as the math is correct, it's not a problem."