Forum - Questions & Answers

May 12th, 2011 - Shannan 28 

Billing Gamma Injections

Hi my name is Shannan and I am new to this forum. I have a question about Gamma injections and am praying that someone can help. We bill electronically and recently went to a new practice management system. I used to bill for HCPCS J1460. We got reimbursed at full rate for this injection. However in our new system it is requiring the NDC number and the way we measure and the number of units administered and the price. Can someone please explain this to me. What is the correct unit of measurement and are they wanting to know how many units were administered in the drug information form and in the quanity field on the cms form.
The only thing clearly asked is the cost per unit charge. Has anyone else had issues with this lately?

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May 12th, 2011 - jschmutz   323 

re: Billing Gamma Injections

Shannan,


Gamma globulin (intramuscular) is reported in units for each cc used. If your physician injected 5cc then you would bill five units of J1460 (up to 10cc or 10 units).


J1460 Injection, gamma globulin, intramuscular, 1 cc


The NDC number is the National Drug Code and this is required for Medicaid claims as of 2008.


Effective January 1, 2008, this provision requires all claims for physician-administered drugs (including drugs administered by nurse practitioners, licensed midwives and drugs administered in an ordered ambulatory setting) submitted on 837 claim formats include the 11-digit NDC, the NDC dispensing quantity, and the NDC unit of measure, in addition to the CPT/HCPCS code and units. The NDC information can be obtained from the drug invoice and/or packaging information. Drugs subject to this provision include drugs commonly administered and billed in the ambulatory setting (e.g., chemotherapeutics, immune globulins, etc.). Vaccines are excluded from this requirement. Also note that physician-administered drug claims submitted on paper will not require entry of the NDC information at this time but will in the future.


 

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