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Histafed Injection

  1. #1
    Default Histafed Injection
    Medical Coding Books
    Histafed aka Bromphneramine injection is being denied with HCPCS code J0945. Insurance states this is OTC rx and physicians should not bill....they state there is a more
    appropriate code available for Histafed. Per HCPCS, J0945 is correct. Any ideas on how to get the injection paid/approved?

  2. #2
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    Columbia, MO
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    The information I have is that this is classified as a self administered drug. This is designated in the HCPC book as such. Perhaps this is why the denial. What dx code are you giving it with and what is the circumstance for the office to be the once administering the injection.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default Histafed inj
    Patient presents with sinus infection,etc and it is decided to give them the injection of histafed. Dx falls under sinusitus.

  4. #4
    Location
    Columbia, MO
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    Ah I looked futher, this is not an injectable it is an oral medicine it is not administered as an injection at all. This is why it is denied as OTC.. Are you certain it was an injection the physician gave? or does he just state that the drug was given.
    Active Ingredient: brompheniramine maleate
    Dose Form Descriptions: liquid; powder; solution; tablet
    Route Descriptions: compounding, oral
    Brompheniramine Maleate Strength Descriptions: 10 mg/mL; 2 mg/5 mL; 4 mg

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default Histafed
    Brompheniramine maleate code j0945 per hcpcs is a injection and is approved by medicare as not only self administered for long-term use patients but acceptable for physician/nurse to administer for acute care patients who would not nomally give themselves an injection.

    It is given subcutaneously.

  6. #6
    Location
    Columbia, MO
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    You may have to appeal then the only information I could get to come up all pointed to oral suspension for this drug. Did you also bill an admin code to show injection? also the Medicare listing I have that has this drug listed shows a 0.00 dollar allowable. Very confusing.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
    Columbia, MO
    Posts
    12,526
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    here's a thought what about your NDC number? That should show it as an injectable and not oral. Have you checked that.

    Debra A. Mitchell, MSPH, CPC-H

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