Urology Coding Alert

Question: I need some help in choosing a J code. We have a Provenge patient that we saw. Demerol 25mg was pushed through IV. The Demerol used is as follows: Demerol Injectible in Carpuject with luer lock 50mg/1ml and the doctor used half (25mg). Since the J code for Demerol (J2175) is for 100 mg, I am not sure how to code and bill this.

Arizona Subscriber

Answer: If the Demerol 100 mg dosage vial cannot be used completely at one time, but is partially used and the remaining/residual medication discarded, you should nevertheless bill for the full amount of Demerol. So you will bill for the 100 mg originally in the syringe using HCPCS code J2175 (Injection, meperidine hydrochloride, per 100 mg). Use “1” in the unit column and bill for the full amount (100 mg).

In the medical records indicate the amount of Demerol used and the amount wasted. On the CMS-1500 submission form (in box 19) or the equivalent space in an EMR submission, report the name of the drug, how it is dispensed, the amount used, the amount wasted, the national drug code number, and the price paid for the drug. This latter information is needed to allow proper payments by the insurance company.