Otolaryngology Coding Alert

Question: AJ code injection's description specifies 100 mg. Our office administers 50 mg of the medicine from a multidose vial. Which of these three methods should we use to bill for the supply: appending modifier -52 to the J code and leaving the 100-mg price; using the J code and dividing the price in half; or billing the J code and leaving the 100-mg price with a claim transaction note indicating how much of the medicine the staff administered?

South Carolina Subscriber

Answer: When billing for a partial supply from a multidose vial, you should bill the J code and adjust the price. For instance, a nurse administers 50 mg of Demerol HCl from a two-dose vial. Code J2175 (Injection, meperidine HCl, per 100 mg) specifies 100 mg and costs 48 cents.

To indicate you administered half the dose, you would divide the price in half. So, you would charge J2175 at 24 cents. The price adjustment signifies that you didn't administer the full dose, so a note stating you gave 50 mg is unnecessary. You don't need to use modifier -52 (Reduced services) to indicate that you administered a partial supply. Modifier -52 is for CPT codes only, not HCPCS Level II codes. The HCPCS Level II manual doesn't list modifier -52 as an accepted modifier.