Wiki J9040 bleomycin, billing partial

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JesseL

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Provider injected 0.1 cc of bleomycin to wart.

The code J9040 is for 15 units (the whole vial).

Do I not bill it at all since the provider didn't use the whole bottle?
 
You can bill for the drugs used for intralesional injections. However, treatment of warts appears to be an off-label use of this particular drug. I'd suggest you may wish to discuss with your manager or compliance officer and do some additional research to confirm that it is appropriate to bill for this service and if so, what is the most appropriate way to bill. My guess is that since this is not a FDA approved use and dosage, that's why a HCPCS code with this corresponding dosage has not been created.
 
CodingKing said:
I would think the chemical injected into a wart would be inclusive in the lesion destruction procedure. J9040 is used for chemotherapy treatment.

http://www.rxlist.com/blenoxane-side-effects-drug-center.htm
Click to expand...

would I use 96405 for the injection? I normally bill only 17110 when the doctor does cryotherapy & the bleomycin injection. This time she only did the injection.

Also the thing with 96405, for some reason it gets denied without the drug code... I get per "medicare rules" denials. Would I just bill j9040 with 0 units?
 
You need to calculate the total number of units you injected. How many units was in the 0.1CC?

J9040 is for 15 units of belo administered.

Lets say you injected only 3 units, but since the J-code J9040 is for 15 units administered You still round up to to J9040 x 1. You cannot bill for a partial J9040. You always round up to the nearest.

Also, use 11900 series for warts. Bleo is used for wart injections quite frequently in dermatology.
 
ellzeycoding said:
You need to calculate the total number of units you injected. How many units was in the 0.1CC?

J9040 is for 15 units of belo administered.

Lets say you injected only 3 units, but since the J-code J9040 is for 15 units administered You still round up to to J9040 x 1. You cannot bill for a partial J9040. You always round up to the nearest.

Also, use 11900 series for warts. Bleo is used for wart injections quite frequently in dermatology.
Click to expand...

I think it's 15 units per a cc.

11900 even though its a chemotherapy drug?

I've always used 96405 for 5FU to warts but not sure about the bleomycin.

And with the drug code, you always report it with 1 unit even though you didn't use the full dosage of the code? (ex J3301 kenalog 10mg report, 1 unit even though 2mg injected?) Was never too sure about it.

Thanks.
 
Yes, always round units UP to the nearest unit. Pay attention to mg vs. ccs vs. units. It can get confusing.

The 96405 code is usually used for antineoplatic injections for malignant lesion treatment, not warts.

From the AAD's Derm Coding Consult,, Fall 2007

Q. Would it be appropriate to bill for 11900 plus the Bleomycin on the last visit?

A. When Bleomycin is used as the method of destruction, the intralesional injection code, 11900 or 11901 would be reported along with J9040 Bleomycin sulfate. The code J9040 is for 15 units of Bleomycin sulfate.

From the AAD's Derm Coding Consult, Fall 2009

Q: Can code 96405-96406 be used for injecting bleomycin into warts?

A: No. Codes 96405 and 96406 are used for injecting such drugs as alpha interferon for the treatment of cutaneous malignant lesions.
 
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