Wiki Coding J1070 vs. J1080

[ctrueblood]

Our provider gives exactly 150mg from a 200mg vial with 50mg wasted.
Can I code for waste or downcode to 100mg?

J1070 Injection, testosterone cypionate, up to 100 mg
J1080 Injection, testosterone cypionate, 1 cc, 200 mg

 

[bclark003]

How should we code for 250 mg of testosteron cypionate from a 10 ml, 200 mg/ml vial? Nothing is wasted and we can give a 1/2 mg..........is it more appropriate to bill

J1080 x 1 and J1070 x 1 or
J1070 x 3

 

[OCD_coder]

HCPCS descriptions:
J1070 100 mg
J1080 200 mg

If the patient is given 150 mg, billed J1080 x 1.

If the patient is given 250 mg, bill J1070 x 1 and J1080 x 1.

You bill the closest match to the units described in the HCPCS to what was given. Adding in all waste until a full unit is reached. Waste only applies to single-dose-vials. Multi-dose vials are not allowed to bill for wastage, just as a side rule. When an incomplete unit or the amount of drug given falls between two available drug HCPCS codes, you roll up to the higher drug unit like with the 150 mg example.