# IV drug infusions - Drug/Substance codes (J codes)



## nestes22 (Sep 12, 2016)

Can someone please help me, I feel like I am at a total loss here. 

My question is about coding for infusion therapy - after coding the level of effort (time) and the type of infusion (initial, subsequent, concurrent, etc..)

How do I code the substances themselves when it is a mixture. For example lets say my patient is getting an infusion of the following mixture:

Magnesium Chloride hexahydrate
Selenium
Calcium gluconate
Ascorbic acid
Thiamine
Riboflavin
Niacinamide
Pyridoxine hcl
Hydroxocabalamin


Should I code each ingredient (drug/substance) individually like below:

Magnesium Chloride hexahydrate (Magnesium sulfate – J3475 x1) 
Calcium gluconate  - Per 10ml – IV – (J0610 x1)
Thiamine – per 100mg (J3411 x1)
Pyridoxine hcl – per 100mg - (J3415 x1)
Hydroxocobalamin – per 1000 mcg - (J3420 x1)

These I do not see listed in my HCPCs Manual so should I just code them to the "unclassified drug" as shown below?
Ascorbic acid – (J3490 x1)
Selenium J3490 
Riboflavin - J3490
Niacinamide - J3490


Or should this entire infusion be coded as a compound using the code J7999?

Any help on this even if it is just pointing me to a IOM is greatly appreciated!!


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## danskangel313 (Sep 12, 2016)

nestes22 said:


> Can someone please help me, I feel like I am at a total loss here.
> 
> My question is about coding for infusion therapy - after coding the level of effort (time) and the type of infusion (initial, subsequent, concurrent, etc..)
> 
> ...



I'm not sure if I can help but...

The first thing I noticed was this sounds very very similar to a Myers' Cocktail, I think only one drug is missing. I know there's been discussion about billing cocktail codes, but I don't know of anyone that has been successful doing this. I also know that getting vitamin cocktails paid for is a tough road.

Somewhere in the CPT book, there's a guideline that states "When multiple drugs are administered report the service(s) and the specific materials or drugs for each." It's my understanding that substances mixed together in one bag can only be counted as one infusion. If you follow the above guideline, if you bill for the _one_ infusion and you bill for each of the multiple drugs on the same claim, I assume there would/should be an obvious understanding by the payer that all the drugs listed were combined in the one infusion. This is also supported by the guidelines for drug waste reporting. You'd need each drug to be listed separately so that if one of them had waste to report, there would be a corresponding supply code to indicate the amount used.

Ascorbic acid is a form of vitamin C and Riboflavin is vitamin B2, but I couldn't find a code for these, even using the vitamin names. For Niacinamide and Selenium, I couldn't find anything either. I think you're left with no option other than to report them as unclassified drug. You'd need to list each one separately because you have to provide the NDC for each. 

On a totally unrelated note, Selenium is part of the medication in anti-dandruff shampoo.


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## nestes22 (Sep 12, 2016)

danskangel313 said:


> I'm not sure if I can help but...
> 
> The first thing I noticed was this sounds very very similar to a Myers' Cocktail, I think only one drug is missing. I know there's been discussion about billing cocktail codes, but I don't know of anyone that has been successful doing this. I also know that getting vitamin cocktails paid for is a tough road.
> 
> ...




Thanks, this helps clear up a bit of my confusion.


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