Jess1980
Networker
Can anyone help me with the correct way to code medications for pain pumps? My office is only using part of the 50 mg vial for J2274. I'm finding conflicting ways to code the number of units.
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Wiki Medications for pain pumps
- Thread starter Jess1980
- Start date
SharonCollachi
Guest
First, is it a single or multi-dose vial? Since J2274 is morphine, preservative-free for epidural or intrathecal use, 10mg, I'm going to go with single-dose vial. If your vial is NOT this description, please post the particulars so we can get it right.
So J2274 is billed per 10 mg, and there are 50mg in your vial. Maximum coming out of that vial is 5 units. Let's say you use 4 units, or 40 mg, and let's say you decide to bill $50 per unit of 10mg.
4 units.... J2274... $50 each..... $200.00
1 unit..... J2274-JW....$50......... $50.00
Make sure you check the NDC code on the vial every time you fill.
So J2274 is billed per 10 mg, and there are 50mg in your vial. Maximum coming out of that vial is 5 units. Let's say you use 4 units, or 40 mg, and let's say you decide to bill $50 per unit of 10mg.
4 units.... J2274... $50 each..... $200.00
1 unit..... J2274-JW....$50......... $50.00
Make sure you check the NDC code on the vial every time you fill.
Jess1980
Networker
Thank you so much Sharon. I will followup with you.
lcole7465
Expert
Hi Sharon -
I have a question on this matter also, my doctor does Morphine pain pumps and he wants to use J2274 when he does this refill. However, in reading the description of the code, this is not the correct code. He is using Morphine Sulfate Pentahydrate USP Powder 100gm along with Sodium Chloride & Sterile Water. And I'm getting a denial from Medicare that J2274 is not billable with the modifier -KD.. Any input on this would be greatly appreciate.
Thanks
SharonCollachi
Guest
My MAC only used the modifier KD for external devices, not implanted pumps, and therefore could only be billed to the DMEPOS. Look for info from your MAC.
From what I could find (and I'm no chemist), morphine sulfate and morphine sulfate pentahydrate are considered to be equivalent. What is the mgs and milliliters of the final product after reconstitution? For example, 50 milligrams per milliliter, total of 20 milliliters.
The FDA put out an advisory in 2018 warning physicians to check the documentation for the pain pump and to ONLY use the medication and formulation that is approved for that pump. They specifically said NOT to use compounded medications, which are often at a higher concentration that ready-made medications. Pain pump patients generally need far less medication, around 1% of the oral dose. Most pumps hold 18-20 milliliters (so if your doc says 100 milliliters, I would say you might want to check your math).
Hi Sharon,
I have a question about these too. An example of the what we usually supply is 10 mg/ml of Morphine sulfate for epidural/intrathecal use. We reload the pump chamber with 40 ml of a 50 ml prefilled syringe. In this scenario would we be correct in billing J2274 40 units and J2274-JW 10 units?
I have a question about these too. An example of the what we usually supply is 10 mg/ml of Morphine sulfate for epidural/intrathecal use. We reload the pump chamber with 40 ml of a 50 ml prefilled syringe. In this scenario would we be correct in billing J2274 40 units and J2274-JW 10 units?
SharonCollachi
Guest
I'm editing to change my answer, because I missed that it was 50ml and not 5ml.
Yes, you are correct. 10 mg/ml, 50ml container is 500mg total. Bill per 10 mg, so max doses is 50.