Urology Coding Alert

Question: How should we bill for dispensing Triple Mix to the patient?

Rhode Island Subscriber

Answer: A prescription for the mixture compounded by the pharmacist and paid for by the patient on his drug plan is probably the easiest and most cost-effective method. Use J2760 (Injection, phentolamine mesylate, up to 5 mg), J2440 (Injection, papaverine HCl, up to 60 mg) and J0270 (Injection, alprostadil, 1.25 mcg [code may be used for Medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered]). Determine their cost by units, and bill per unit. For example, J0270 is billed at 1.25 micrograms per unit. Ten micrograms injected would be eight units billed, that is, eight times the dollar value per unit. Ask your carrier for its policy on the frequency of administration and payment. Most carriers will only pay for one injection by the physician. Rhode Island Blue Cross and Blue Shield will pay for two injections.