cpt code and description
J7040 – Infusion, normal saline solution, sterile (500 ml=1 unit)
J7050 – Infusion, normal saline solution , 250 cc
J2405 – Injection, ondansetron hydrochloride, per 1 mg
J2930 – Injection, methylprednisolone sodium succinate, up to 125 mg
Background:
Effective April 1, 2002, CWF edits were implemented to identify HCPCS codes for ambulance services that are either subject to or excluded from Skilled Nursing Facility (SNF) consolidated billing (CB). This coding change added SNF CB edits to CWF to deny payment of some separately billed ambulance services for beneficiaries in a SNF Part A covered stay. Effective July 1, 2003, CWF added an edit to allow claims submitted with specialty type “59” and CPCS codes J7030 or J7050 (Saline Solution Injection) to process and pay correctly for modifiers other than “NN” when a beneficiary is in a Part A stay, and for claims submitted with an “NN” modifier when the beneficiary is not in a Part A stay. Since the implementation of this update, CMS has identified additional HCPCS codes for drugs and CPT codes for electrocardiogram (EKG) testing that may be separately payable when provided during a SNF ambulance transport that is not subject to SNF CB. HCPCS J-codes (J0000-J9999) not included in previous updates, Q-codes for anti-emetic drugs (Q0163 through Q0181), and CPT codes for EKG testing (93005 and 93041) will be added to the CWF SNF CB bypass for ambulance specialty type “59” carrier claims during the October 2004 SNF CB quarterly update.
Intravenous administration includes all methods, such as gravity infusion, injections, and timed pushes. The ‘VAR’ posting denotes various routes of administration and is used for drugs that are commonly administered into joints, cavities, tissues, or topical applications, in addition to other parenteral administrations. Listings posted with ‘OTH’ indicate other administration methods, such as suppositories or catheter injections.
Saline solution, sterile 500 ml = 1 unit IV, OTH J7040
Services Incorrectly Coded and Unbundling
Billed HCPCS J7050, and CPT 85025 and 36591.
HCPCS J7050 – Billing for J7050- Normal saline solution 250cc, (3) units = 750cc. Documentation supports 150cc for medication use and would allow 250cc for a maintenance line. Change units of service from (3) to (2) = 500cc.
Billing for 85025- blood count; complete (CBC), automated (HGB, HCT, RBC, WBC and platelet count) and automated differential WBC count. Physician’s order is for a CBC, no differential was ordered. Resulted is a CBC with differential. Change code from 85025 to 85027- Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet.
Per the physician’s fees schedule, billed code 36591(Draw blood off venous device) is listed as T statusonly paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the physician services for which payment is made. Payment is made for E/M services as well as infusion therapy. Unbundling.
Drug
Medicare Administrative Contractors (MACs), many private payers, and most Medicaid agencies require healthcare providers to use Healthcare Common Procedure Coding System (HCPCS) codes to identify infused drugs on claim forms. HCPCS codes have a 5-character alphanumeric format and are used to bill for supplies and services not described by the Current Procedural Terminology (CPT), 4th Edition, coding system. The following HCPCS code may be used to describe REMICADE® (infliximab) on claim forms submitted from the hospital outpatient setting:
• J1745 Infliximab 10 mg
Although the National Drug Code (NDC) is usually reserved for billing by pharmacies, some private payers and the majority of Medicaid fee-for-service programs require an NDC for billing instead of, or in addition to, an HCPCS code, for physicians and other service providers as well. Although the FDA uses a 10-digit format when registering NDCs, payers usually recognize and often require an 11-digit NDC format on claim forms for billing purposes. It is important to confirm with your payer which NDC format they require. Guidelines for reporting the NDC in the appropriate format, quantity, and unit of measure vary by state and by payer, and should be reviewed prior to submitting a claim. The 10-digit NDC and 11-digit alternative NDC formats used for REMICADE® 100 mg are:
• 10-Digit NDC format: 57894-030-01
• 11-Digit NDC format (used by most payers): 57894-0030-01
Payers’ policies regarding separate payment for saline used to administer IV drugs vary. Hospitals may need to record costs on claims even though saline is not separately reimbursed (ie, it is bundled into the APC payment for infusion services). If billed on the claim form, the following HCPCS code describes saline used to administer REMICADE®:
• J7050 Infusion, normal saline solution, 250 mL
Billing Examples
1.) Patient receives 4 mg Zofran IV in the physician’s office.
• NDC package display: 00173-0442-02
• Descriptor: Zofran 2 mg/ml in solution form
• 2 ml per vial
Report:
• J2405 (ondansetron hydrochloride, per 1 mg)
o 4 HCPCS units
• 001730442025 (NDC Number)
o ML2 (2 millimeters NDC units)
2.) Patient receives 1gram of Rocephin IM in the physician/s office.
• NDC for the product used: 00004-1963-02
• Descriptor: Rocephin 500 mg vial in powder form, reconstituted prior to injection.
Report:
• J0696 (ceftriaxone sodium, per 250 mg)
o 4 HCPCS units
• 00004196302 (NDC number)
o UN2 (NDC units as 2, also called 2 each)
3.) If the patient in the first example above (Example 1) received a partial vial, only 2 mg of Zofran, use the same NDC which is for Zofran 2 mg/ml in a 2 ml vial:
Report:
• J2405 (ondansetron hydrochloride, per 1 mg)
o 2 HCPCS units
• 00173044202 (NDC Number)
o ML1 (1 millimeter NDC units)
