Wiki Proper billing of Injectibles

[msschnet]

We are an Endocrinology practice that administers Thyrogen injections to some of our patients. We DO NOT PURCHASE the Thyrogen. The patients bring the medicine to us to be administered. We have been billing an administration code for this service. However, BCBS especially and some other payers, are requiring us to bill J3240 - Thyrogen 0.9mg. with code 96372. I'm uncomfortable with this since we have no dealing with the medicine, just the administration. Is it proper to bill 96372 and J3240 with the "J' code showing zero? By billing it, do we imply that we're just not charging for it.

I would appreciate any advise or specific references regarding this issue. All the reference material provided by the payer indicates that we are financially involved in the Thyrogen. They have verbally told us to bill the code with a zero but will not give that to us in writing.

Thank you for your assistance.

 

[mitchellde]

The medical necessity for an injection is tied to the drug not the administration, the payer needs to evaluate the drug with the diagnosis to determine if they will pay for the administration. So yes you use the code for the drug with $0 charge. Some systems will not allow a $0 charge and for this reason it is allowed that you may bill $.01 as long as you adjust it off on the back end.

 

[msschnet]

Thank you very much for your quick and knowledgeable reply. This is a tremendous help.