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How to figure out the correct charges for injections

  1. #1
    Default How to figure out the correct charges for injections
    Medical Coding Books
    I am needing some guidance on figuring the correct amount to charge on injectable drugs. The previous biller never billed for any injections that were given at the office I am currently working in. I am trying to bill for an injection of toradol and in my software the code was never added along with the amounts. I have looked at the fee schedule on my MAC website (cahaba) and the CMS web-site but am very confused on how to figure the amount that can be billed. Any advice or guidance would be greatly appreciated. (The patient has BCBS actually so do I need to look there for pricing?)
    Sheri Meadows

  2. #2
    Location
    Baton Rouge
    Posts
    1,241
    Default
    Quote Originally Posted by smeadows177@comcast.net View Post
    I am needing some guidance on figuring the correct amount to charge on injectable drugs. The previous biller never billed for any injections that were given at the office I am currently working in. I am trying to bill for an injection of toradol and in my software the code was never added along with the amounts. I have looked at the fee schedule on my MAC website (cahaba) and the CMS web-site but am very confused on how to figure the amount that can be billed. Any advice or guidance would be greatly appreciated. (The patient has BCBS actually so do I need to look there for pricing?)
    I recommend (and I've seen others post similar advice) gathering the info on all the drugs your clinic injects/administers--the amount you pay, the fees each payer pays, etc. Set your fee at a certain percentage above invoice cost, for example 50%, and see if that puts your fees above the fee for all of your payers. If yes, you're at a good point. If not, go higher. But this will allow you to be consistent across the board. Will just need to compare your cost on a regular basis to make sure your fees keep up with drug cost increases.

    Hope that helps!
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  3. #3
    Default
    Thank you. That does help to give me a jumping off point.
    Sheri Meadows

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