Primary Care Coding Alert

Question: A J-code injection's description specifies 100 mg. Our office administers 50 mg of the medicine from a multi-dose 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 multi-dose vial, you should bill the J code and adjust the price depending on payer.

For instance, a nurse administers 50 mg of Demerol HCI from a two-dose vial.  Code J2175 (Injection, meperidine HCI, per 100 mg) specifies 100 mg and costs $0.48.  Some insurers, such as Kansas Medicaid, permit entire vial billing.  In this case, you should submit J2175 at $0.48. 

Other payers may want you to bill the actual dose cost.  To indicate your administered half the dose, you would divide the price in half.  So, you would charge J2175 at $0.24.  A note stating you gave 50 mg is unnecessary.

You don't need to use modifier -52 (Reduced services) to indicate 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.