Wiki needing advice on billing injections

[cghanbari]

I have been having problems with being reimbursements with BCBS. When I call I am being told that our billing format is wrong. This all started the beginning of the year. The will not tell me what is wrong with the format
Can anyone tell me how you are billing 20 mg of J1380. The units, the ndc unit count, the ndc unit measurement. We were being payed just fine until the beginning of January 2014. Any advice would be appreciated
Thanks

 

[Saedron]

If I'm reading this right, your billing would be as follows:

each unit of J1380 is (up to) 10 mg. So your unit measurement is 10 mg.
your billing would be J1380 x 2 for 20 mg so your unit count is 2

If you are billing J1380 as a single unit at 20mgs that may be the problem.

 

[nvandepol]

Are you submitting the claim electronically or paper? Did anything change in your internal format?

 

[cghanbari]

We are submitting electronically. what changes in our format is that we had to add ndc measurement count. ever since then our reimbursements have been lower.
BCBS is saying it is that is wrong. if you have access to availaity you can look at how to caluculate J1380. They give several ndc numbers:
42023-0110-01 delestrogen 10 mg billable units is 5
42023-0111-01 delestrogen 20 mg billable units is 10
42023-0112-01 delestrogen 40 mg billable units is 20
We usually give 20mg/ ml. so is the this saying bill 10 units and my ndc measurement count is 1 ml. and I put in the ndc for delestrogen 20mg because that is the vial I drawn 1 ml from. BCBS says the reimbursement for delestrogen is 9.90 per 10 mg. but I am only getting reimbursed Aprox 13.00 for brand delestrogen 20 mg so we are actually loosing money!!. I guess its best to go self pay, but the patients will have a fit!