Wiki Help with J0696 (Ceftriaxone) - documentation to support

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stephwade

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We are having quite a debate regarding how many units to bill for on 1 gm of Ceftriaxone. From everything I've found I think I am supposed to bill it as J0696 x4 units. The NDC # I am using falls under the j0696 on the NDC crosswalk. My Dr's office is saying this is wrong because they only used 1 vial of a 1 mg. dose. Which is correct and where can I find documentation to support the correct answer. This is stressing me out so thanks so much in advance for any answers!!
 
In our office, we bill 1 gram as 4 units. We bill it out in increments of 250 mg as 1 unit. Haven't had any trouble doing it this way. We are affiliated with our hospital, so I believe our pharmacy was the ones that originally told us to bill this way.
 
Our office also uses a ton of ceftriaxone, and are also dealing with NDC numbers. If you gave 1 gram of ceftriaxone, you would use the code J0696 with 4 units, which is equal to 1000 mg, but make sure that you are using the correct NDC per vial. I actually had to set up three separate J0696 codes to deal with the 3 differenct vials of J0696, along with 3 separate NDC numbers. The code J0696 is per 250 mg, not sure if any of this helps. Good Luck!
 
Thanks to both of the responders. Everything I have read says to bill 4 units as you both have said, I just can't convince the nurses that this is correct. We had problems with NDC codes in the beginning. I have begun to pull them up on the NDC lookup to get the exact name and dosage before I code them and that seems to help a lot.
 
The reason you bill J0696 X4 is because it comes in a 1gm vial. This vial is a "single" dose. So, even if you just give the pt 500mg, you have to discard the remainder. This is why you bill for the full 1gm. If, you are giving the other 500mg to "another" pt and bill both at X4, this is FRAUD. We use it here almost daily. I work in an oncology & hematology facility.
 
we bill alot of rocephin 1gm here and we bill it as J0696 X 4 units and don't have any problems. it's billed per 250mg per the CPT book which should be enough documentation to support how you're supposed to bill it. hope this helps
 
we made the drug rep give us NDC numbers. they can speak to the clinical staff and explain how the drug is supplied, the NDC number is usually on the product information. if they want to continue to sell drugs to you, they are most helpful.
 
Rocephin

I know this is an old post but I too constantly have issues getting reimbursed especially from NC Medicaid. If any of you file this with NCMED and are successful getting paid please share how you code this. I use J0696 and adjust units to match dosage, I also file 96372 which I am reimbursed for but I can not get them to pay for the medication. Do you use any modifiers on the J0696 code?

thanks
 
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