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Coding Clinic for HCPCS - Fourth Quarter 2018 Page 5,6 Effective Date: December 24, 2018
Reporting multiple units of drugs
Recently, the Central Office on HCPCS has received several inquiries regarding the appropriate reporting of HCPCS J codes for multiple units of drugs. In response to these questions, we have put together this article to provide guidance that will assist you in the reporting of multiple units of drugs.
When reporting units of drugs the coding professional must review the documentation to:
•Confirm that the amount of the drug(s) being administered is accurately reported in terms of the dosage specified in the long descriptors for the applicable HCPCS code(s).
•Report units in multiples of the dosage included in the long HCPCS descriptor. If the dosage is not a multiple of the number provided in the HCPCS code description, then the coding professional should round up to the nearest whole number.
In other words, the unit of drug should be reported based on the way the drug is administered to the patient, not on the way it is packaged, stored or stocked. When the drug dosage amount provided to the patient is greater than the amount indicated in the long descriptor for the applicable HCPCS code, the reported units should be rounded up. When the drug dosage amount is less than the amount indicated in the long descriptor for the applicable HCPCS code, report 1 as the unit of measure.
Drug strength versus unit dose
When reporting the HCPCS J code for the drug administered it is important to understand the information provided in the long descriptor of the HCPCS code. For example, let us look at HCPCS code J1030, Injection, methylprednisolone acetate, 80 mg. The HCPCS long descriptor provides information needed to accurately capture the drug administered, such as:
•Strength
•Unit dose
•Method of drug administered
•Generic name of drug
The strength is the amount of drug in a given dosage form, example: 80 mg. The unit dose is the amount of drug in the dosage form or the way the drug is packaged, example: 80 mg. Therefore, the strength and unit dose are one and the same. However, the unit of drug is reflected in the HCPCS code assignment, example: Patient given 160 mg of methylprednisolone acetate, so the unit of drug would be indicated by 2 units (i.e., 80 X 2) of HCPCS code J1040.
Remember, when reporting units of drugs, the documentation in the health care record must reflect the drug and the dosage administered. Additionally, the units of drugs must be accurately reported in the terms of dosage specified in the HCPCS long descriptor.
Let us look at a few questions and answers below:
QUESTION 1
Are HCPCS codes J1020, Injection, methylprednisolone acetate, 20 mg, J1030, Injection, methylprednisolone acetate, 40 mg, and J1040, Injection, methylprednisolone acetate, 80 mg, supposed to be reported based on the strength of the drug, or by the dose given? For example, what is the correct code to report for 8 mg given from a 40 mg/ml bottle of Depo-Medrol?
ANSWER
Units of drugs are not reported based on the strength of the drug. Drugs are appropriately reported based on the way the drug is administered to the patient, not on the way it is packaged, stored or stocked. When the drug dosage amount provided to the patient is greater than the amount indicated for the drug HCPCS code, the reported units should be rounded up. When the drug dosage amount is less than the amount indicated for the drug HCPCS code, report 1 as the unit of measure.
In response to the example provided, if 8 mg are given from a 40 mg/m bottle of Depo Medrol only 1 unit of HCPCS code J1030, Injection, methylprednisolone acetate, 40 mg, would be reported.
QUESTION 2
What is a "per unit" dose? In HCPCS codes J1020, Injection, methylprednisolone acetate, 20 mg, J1030, Injection, methylprednisolone acetate, 40 mg, and J1040, Injection, methylprednisolone acetate, 80 mg, the code descriptions are the strengths of the medication. What is the proper coding when 60 mg of Depo-Medrol is given from 2 40 mg/ml vials?
ANSWER
Drugs are appropriately reported based on the way the drug is administered to the patient, not on the way it is packaged, stored or stocked. A "per unit" dose is the amount of drug in the dosage form or the way the drug is packaged.
Therefore, for a patient receiving 60 mg of methylprednisolone, you can either report 3 units of HCPCS code J1020, Injection, methylprednisolone aceteate, 20mg, or 1 unit of HCPCS code J1030, Injection, methylprednisolone acetate, 40 mg, and 1 unit of HCPCS code J1020, Injection methylprednisolone, which would equal 60 mg administered.
QUESTION 3
What is the appropriate code assignment for a patient that receives 3 mg of Celestone? HCPCS code J0702 states "Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg."
Would it be appropriate to assign 1 unit of HCPCS code J0702? What if 6 mg of Celestone is injected, would that be 2 units?
ANSWER
Units of drugs are reported based on the way the drug is administered to the patient, not on the way it is packaged, stored or stocked.
Therefore, if 3 mg of Celestone in a multi-dose vial was administered to the patient, only 1 unit of HCPCS code J0702 would be reported.
However, if 6 mg of Celestone in a multi-dose vial was administered to the patient, 2 units of HCPCS code J0702 would be reported.