Wiki Medication dose exceeds max. allowable

[kayleeevans907]

I am running into a problem with one payer denying claims that have dexamethasone attached. Our providers generally administer 10mg so we charge 40 units of J8540 (.25mg per unit). The payer I'm having trouble with will only pay for 4 units (1mg).
Is there anything I can do to at least get paid for the 4 units instead of having all 40 denied? My 1st idea is to split the charges into separate line items (one with 4 units the other with the remaining 36) so that less are denied but something about that still feels kind of wrong to me.
Thank you

 

[SharonCollachi]

Are you sure it's not due to that code being for an oral drug and not for an injectable drug? Is there a reason why they're using oral and not injectable (injectables are generally easier to get paid). Well, I should have asked this first - Are you sure they're using oral dex and not injectable?

 

[kayleeevans907]

Are you sure it's not due to that code being for an oral drug and not for an injectable drug? Is there a reason why they're using oral and not injectable (injectables are generally easier to get paid). Well, I should have asked this first - Are you sure they're using oral dex and not injectable?

Not sure how I didn't see this earlier. They specify tablets, I don't know why they choose to use oral instead of injections since I'm fairly certain we carry both for this department and don't recall ever running into this issue with the injectable dex with this payer.