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Epi pens/Auto Injectors

  1. Question Epi pens/Auto Injectors
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    Hi! I work in an allergists office and I was wondering if anyone has any advice for me. We have patients come into the office with their own Epi pens, in case of emergency, but we still carry Epi pens on hand. In the event that we need to use an Epi pen on a patient, I was wondering if anyone had any suggestions on how to get paid for it. Here is our issue. Before I start, I should mention that I am in a loosing argument with my physicians about this, becuase I vote that they need to just draw up the epinephrine and I can bill the J-code and get paid. Our cost if they were to draw it up is minimal. My docs state that they would like to always use the Epi Pens. Their reasoning is that, in an emergency, the rest of our staff (Medical Receptionists and non clinical staff) can easily be trained to use an auto injector, and there is little to no user error. My problem comes in because the only way that I can find to bill the use of Epinephrine is via J code, which bills out at less than $5 and the reimbursment is minimal. The cost of 1 adult Epi Pen for us, varying by vendor, is about $80. Does anyone have any suggestions on a way to bill (and get paid) so that I can recoup some of my costs? Thanks a ton!

  2. #2
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    Quote Originally Posted by Bridget.Levitt@mercy.net View Post
    Hi! I work in an allergists office and I was wondering if anyone has any advice for me. We have patients come into the office with their own Epi pens, in case of emergency, but we still carry Epi pens on hand. In the event that we need to use an Epi pen on a patient, I was wondering if anyone had any suggestions on how to get paid for it. Here is our issue. Before I start, I should mention that I am in a loosing argument with my physicians about this, becuase I vote that they need to just draw up the epinephrine and I can bill the J-code and get paid. Our cost if they were to draw it up is minimal. My docs state that they would like to always use the Epi Pens. Their reasoning is that, in an emergency, the rest of our staff (Medical Receptionists and non clinical staff) can easily be trained to use an auto injector, and there is little to no user error. My problem comes in because the only way that I can find to bill the use of Epinephrine is via J code, which bills out at less than $5 and the reimbursment is minimal. The cost of 1 adult Epi Pen for us, varying by vendor, is about $80. Does anyone have any suggestions on a way to bill (and get paid) so that I can recoup some of my costs? Thanks a ton!
    The only other way you could try to bill for this item is to use J3490 for unclassified drug. You could then bill for the cost of the epi-pen and send along a copy of your invoice showing your cost. Depending on the insurance carrier, they may still deny this since epi is available to physician offices for a far lesser cost as a regular injection.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. Smile
    Ok thanks a ton for the help! I really appriciate it. Ill see what I can do for this for next time around.

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