Wiki Rocephin coding

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ssevans78

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I am having an issue getting my Rocephin codes paid and I can not for the life of me figure out why. So we use 250 and 500mg vials. I gave 750mg to a patient and used a 250 and a 500. In my system the 500mg code is as follows:( Rocephin 500 mg NDC#00781320785 dose amount 500, units:1, dose units: MG) then my 250 is (Rocephin 250 NDC#68180061101 dose amount: 250, units: 1, dose units: MG.)

I had the 500 mg as 2 units and it was denied. The denial they keep giving me is that my MUE is incorrect. but they will not even pay the 250 code so I cannot figure out what is wrong with my MUE(unit of measure). Because now I change the 500 to 1 unit to see what they tell me. But I am sure that it will be incorrect still.

Can anyone help me with this. I know that insurance does not reimburse much for the Rocephin, but hey right now every penny counts.
 
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MUE is not "unit of measure", it is "medically unlikely edits". Which means, it is not medically likely that a patient would receive what you gave them, in that many units, or that often. Now, that doesn't mean this denial is correct. I found a BCBS policy that stated that 16 is the max units per day they will pay. You will need to check with the insurance you are billing to see what the max units per day is, and if there is another frequency (like max 5 days out of every 60 days).

J0696 Rocephin (ceftriaxone sodium) is billed per 250 mg. So 750 mg is a total of 3 units.

I would suggested not combining different vials; you are more likely to get paid for 3 units from one vial than from 2 units from one NDC and 1 unit from another NDC.
 
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I believe the code for milligrams in the NDC field ME, not MG. I'm not sure all payers accept ME though - if they don't, you may need to convert it to on of the units of measure - F2, UN, GR or ML. It's been a long time since I submitted one of these so not sure if this is still current.

And yes, as mentioned above MUE is the abbreviation for Medically Unlikely Units, unless your payer is using this to mean something different - that is for units billed in excess of the usual amount. Medicare allows 16 units of J0696, but it your 500 mg is going across as 500 GR or 500 units instead of mg, that could be causing the problem.
 
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Ah yes, I missed the NDC code part. The units in your NDC are not necessarily the same as the units you bill.

N4 (then the NDC code) then ML followed by the number of milliliters that you injected.
The quantity you are billing is total milliGRAMS divided by 250, since that is the unit of measure.
_________________________________________________________________________________________________________________________
Example 1: You can buy Rocephin in a 250mg/15ml single dose vial.

Your NDC code with the 9's representing the actual code: N499999999999ML15
Your billing line: $$$$ x 1 unit

If you used three of these vials, it would look like this:

NDC: N499999999999ML45
Your billing line: $$$$ x 3 units
_________________________________________________________________________________________________________________________

You can also buy Rocephin in a 500mg/15ml single dose vial.

NDC: N499999999999ML15
Your billing line: $$$$ x 2 units (500mg divided by 250mg)

So in this instance, your ML remains 15, but your quantity is 2
 
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SharonCollachi said:
MUE is not "unit of measure", it is "medically unlikely edits". Which means, it is not medically likely that a patient would receive what you gave them, in that many units, or that often. Now, that doesn't mean this denial is correct. I found a BCBS policy that stated that 16 is the max units per day they will pay. You will need to check with the insurance you are billing to see what the max units per day is, and if there is another frequency (like max 5 days out of every 60 days).

J0696 Rocephin (ceftriaxone sodium) is billed per 250 mg. So 750 mg is a total of 3 units.

I would suggested not combining different vials; you are more likely to get paid for 3 units from one vial than from 2 units from one NDC and 1 unit from another NDC.
Click to expand...
I at first did bill 750 unit 3, but then talked to someone else that said we should bill what we actually use. So since we use a 250 and a 500 and not 3 250 vials we were billing incorrectly. So then I changed it and billed it as a 250 vial and a 500 vial which was still denied as the same problem.
 
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thomas7331 said:
I believe the code for milligrams in the NDC field ME, not MG. I'm not sure all payers accept ME though - if they don't, you may need to convert it to on of the units of measure - F2, UN, GR or ML. It's been a long time since I submitted one of these so not sure if this is still current.

And yes, as mentioned above MUE is the abbreviation for Medically Unlikely Units, unless your payer is using this to mean something different - that is for units billed in excess of the usual amount. Medicare allows 16 units of J0696, but it your 500 mg is going across as 500 GR or 500 units instead of mg, that could be causing the problem.
Click to expand...
Yes in our system we put in MG but on the hcfa it prints out as ME. So maybe it needs to print out MG for amerigroup that could be something I could change on it.
 
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Sorry also let me clarify that my denial reason was DRA1: other: provider is billing an invalid unit of measure (MUE). Sorry I did not word that correctly in my original post.
 
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