Wiki Pain Pump Infusion Drugs

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nicolechaller@gmail.com

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I need some help, hoping I can get some advice...

I'm new to pain management billing and in review of EOB's from Medicare I see the drugs billed for when refilling pain pumps are denied stating "incomplete/invalid documentation/orders/notes/summary/report/chart."

There are so many things I could send so does anyone have any hints on what they actually want?

We supplied the NDC, dosage. KD modifier.... do they want the prescription? The analysis?

Maybe I should just send everything?
 
Pain Management

If nothing else, call your pain pump representative. They may have some handouts that will get you pointed in the right direction.
 
Pain Pump infusion drugs

When billing Medicare for the pain pump refills, you do not bill each drug separately. Instead you bill all drugs with HCPCS code J3490. Medicare will only pay invoice price for pump refills. In box 19 you indicate drug, dosage, price, etc. It should look like this:

Ex:
CmpdRx/40mlvlBac1mg8300/Hyd10mg7700

CmpdRx = tells them it's a compounded med
40mlvl = tells them it was a 40ml vial (Usually will be 40ml or 20ml)
Bac, Hyd = Baclofen and Hydromorphone (use abreviation for drug)
1mg = tells them the dosage
8300, = tells them you spent $83.00 on Baclofen, $77.00 on Hydromorphone

Please note the forward slashes inbetween each drug and also inbetween CmpdRx/40mlvl,
Hope this helps
 
Units for morphine for intrathecal pump re-fill

I need help with correct calculation of number of units to be billed for morphine for intrathecal pump re-fill.

Some commercial insurance carriers want to list specific HCPCS code with modifier KD and number of units.

A pharmacy gave us NDC number and per Noridian crosswalk it crossing over to HCPCS code J2271, Injection , morphine sulfate, 100 mg.
The dose given 1280mg, concentration 64mg/ml and volume of the pump is 20ml.

So, I think the number of units should be calculated as follows
64mg/ml X20 ml / 100mg=12.8 Units. Billed units are 13.

However, I had been told that is incorrect. The HCPCS code J2275, Injection, morphine sulfate ( preservative-free sterile solution) should be used instead and the number of units should be calculated as
64mg/ml X 20ml / 10mg= 128 Units.
 
Occasionally I get the same denial in my practice even though I have the proper dosages and drugs listed in box 19. This is what I send, and have been paid every time:
1. Office note pertaining to that date that details the pump refill
2. The pump analysis report printout
3. The copy of the prescription from the pharmacy that matches the drugs I billed under
J3490.

I think they just randomly do this to make sure providers are following the LCD requirements. But, like I said, mine get paid every time after submitting these records.

Hope this helps!
 
In addition,
It would be in your best interest to look at the LCD for your area. Then just send whatever is listed under the documentation requirement section for that LCD.

:eek:
 
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