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Thread: Drug Code billing

  1. #1

    Default Drug Code billing

    AAPC: Back to School
    When a drug code is "per mg" (ie- J2250 per 1mg) do I code as 2 units when we use 1.75 mg?
    Is there a different way I need to code this?

  2. #2
    Join Date
    Apr 2007


    This manual might be helpful in finding out the answer. Here is some info I pulled from it.


    Hospitals must report all appropriate HCPCS codes and charges for separately payable drugs, in addition to reporting the applicable drug administration codes. Hospitals should also report the HCPCS codes and charges for drugs that are packaged into payments for the corresponding drug administration or other separately payable services. Historical hospital cost data may assist with future payment packaging decisions for such drugs. Drugs are billed in multiples of the dosage specified in the HCPCS code long descriptor. If the drug dose used in the care of a patient is not a multiple of the HCPCS code dosage descriptor, the provider rounds to the next highest unit based on the HCPCS long descriptor for the code in order to report the dose provided.
    If the full dosage provided is less than the dosage for the HCPCS code descriptor specifying the minimum dosage for the drug, the provider reports one unit of the HCPCS code for the minimum dosage amount.
    OPPS Pricer includes a table of drugs and prices and provides

  3. #3
    Join Date
    Apr 2007
    Coastal Coders


    If your software is configured to bill the drug at "X" amount of $$ per unit and the unit is equal to 1 mg then you can bill it at 1.75

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