I am assuming this is in an office and not in an outpatient hospital setting.
Units of J7999 is always one.
Is it compounded or is it multiple drugs? (You're billing commercial as multiple, but billing Medicare as compounded???) Medicare states, "Compounded drugs created by a pharmacist in accordance with the Federal Food, Drug and Cosmetic Act and the FDA Modernization Act of 1997 may be covered under Medicare when their use meets all other criteria for services incident to a physician's service. Compounded drugs do not have a National Drug Code number (NDC).
Mixing two or more pre-packaged products in the same syringe when prepared according to label instructions, does not meet the definition of a compounded drug. Compounded drugs are used to meet the special needs of a patient. Examples of when a compounded drug is used include, but are not limited to the following:
- Patient is allergic to an inactive ingredient in off-the-shelf drug and a compound is made omitting that ingredient
- Dosage strength required is not available when prepared according to label instructions. (For drugs requiring reconstitution, this means after drug has been reconstituted per label instructions.) For example, a drug used in an infusion pump or reservoir may require compounding.
If any part of the mixture is off-the-shelf, then that is listed separately from the part that is compounded, otherwise everything will deny.
You said you put the list under "description", but I don't know where that is going on the HCFA. It should be box 19.
According to the latest price list I have, which may be low, your expected reimbursement is:
Dilaudid 840 x $0.13= $109.20
Sufentanil 235200 x $0.09 = $21,168.00 <-- that's over a gallon (I'm only showing 50 mcg/ml), are you sure that's correct? (50mcg per ml = 4704 mls = 1.24 gallons)
Ketamine 50400 x $0.0048 = $241.92
Bupivicaine 504 x $0.04 = $20.16
TOTAL = $21,539.28
Compound fee = $60.00
Grand total = $21,599.28
So it could be that the total volume is incorrect, it could be that you're filling more frequently than you should be, it could be that you're using medications that aren't actually compounded, it could be that your diagnosis is incorrect, etc.
What are the specific denials that you're getting?