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Oncology & Hematology Coding Alert

Reader Question:

J7185-J7199 May Have Special Units Rule

Published on Fri Aug 05, 2011

Question: We've seen conflicting information on reporting clotting factor units to Medicare. Do we report the number of IUs administered or something else?California SubscriberAnswer: Typically, you should calculate units by dividing the amount administered by the amount listed in the code descriptor. Payers may have specific rules, however.As a Jurisdiction 1 Part B provider reporting clotting factor units for a Medicare beneficiary, you should follow the instructions posted by Palmetto GBA at www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7REJY77083?opendocument&utm_source=J1BL&utm_campaign=J1BLs.Palmetto instructs its Jurisdiction 1 providers to "divide the number of International Units (IUs) administered by 100 and round to the nearest whole number." It also offers specific rounding rules that you should follow: Fraction from .50 to .99 = 1 additional billing unit Fraction from .01 to .49 = NO additional billing unit. Palmetto offers several examples, including the following:Example 1: Suppose the patient receives 1,232 IU. You should divide 1,232 by 100. The result is [...]
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