coding for infusion medication dosages

My physician is giving Remicade (J1745) infusions in the office to his rheumatology patients. My question is, code J1745 says for 10mg which is one vial, but often they give more than one vial. They note the number of vials in the documentation. Should I be billing for more than one vial when used or am I only allowed to bill for one per date of service? If I can bill for more than one do I need to just code it once J1745 and change the quantity accordingly or do I bill code J1745 multiple times (once for each vial)?

remicaide

We code Remicaide J1745 times the amout given divided by 10. For instance, if 400 mg Remicaide is infused I code J1745 X 40 units. I don't have any problems getting reimbursed correctly.

remicade

verify the mg on the vial: Remicade is available in 100-mg vials. The dosage associated with the HCPCS code is 10 mg. The number of units (rounded up to a whole unit) used, should be entered in Block 24G of the HCFA 1500 claim form. For electronic claim submissions, this information should be reported as indicated below:

National Standard Format (NSF) Version 3.01, FAO record, field 18.0

American National Standards Institute (ANSI) X12N837, Version 30.51 2-370-SV104

The following is an example of the correct reporting methodology for Remicade: If the dosage administered is 375 mg, 4 vials (or a total of 400 mg) will be used. Report this with a “40” in the units field.

Remicade billing

Each Remicade (infliximab) vial is 100mg. J1745 is a fractional code, representing 10mg. Therefor, if 1 vial is used you would bill 10 units of J1745, 20 units if 2 vials are used, etc.