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I have a question about coding J9355. They come in units of 10 mg and are billed in increments of 10. What if only half a unit was used. Can we code for 1/2 of J9355? Can anyone direct me to a reference about this?
I have a question about coding J9355. They come in units of 10 mg and are billed in increments of 10. What if only half a unit was used. Can we code for 1/2 of J9355? Can anyone direct me to a reference about this?
I don't know if this helps, but this is from the CMS website:
CMS Manual System
Department of Health & Human Services (DHHS)
Pub 100-04 Medicare Claims Processing
Centers for Medicare & Medicaid Services (CMS)
Transmittal 2193
Date: April 22, 2011
The process for dealing with one international unit (IU) is the same as the process of dealing with one microgram.
EXAMPLE 2
HCPCS Drug Dosage Actual dosage:
J9355 Trastuzumab 10 mg 140 mg
On the bill, the facility shows J9355 and 14 in the units field (140 mg divided by 10mg = 14 units).
When the dosage amount is greater than the amount indicated for the HCPCS code, the facility rounds up to determine units. When the dosage amount is less than the amount indicated for the HCPCS code, use 1 as the unit of measure.