Pediatric Coding Alert

Question: We've reported J0540 for years, but Medicaid denied one of our recent claims. Has something changed, and we missed it?

Pediatric Coding Listserv Subscriber

Answer: Your claim's timing could be the problem because HCPCS 2010 deleted J0540 (Injection, penicillin G benzathine and penicillin G procaine, up to 1,200,000 units). If you're billing for charges incurred in 2010, you should report new code J0559 (Injection, penicillin G benzathine and penicillin G procaine, 2500 units) instead.

Although J0540 and J0559 represent the same medication, your calculation formula shifts because J0559 is priced based on the number of 2,500 units used. For example, if the physician administers 1,200,000 units, you'll report J0559 x 480 (2,500 units x 480 = 1,200,000 units).