CORRECT CODING – DRUGS AND FLUIDS


The Pricing, Data Analysis and Coding (PDAC) Contractor has conducted an analysis of supplier billing of miscellaneous drug codes. This analysis showed multiple variances in supplier billing patterns. The following is a list of codes used in the analysis:

J3490

UNCLASSIFIED DRUGS

J7599

IMMUNOSUPPRESSIVE DRUG, NOT OTHERWISE CLASSIFIED

J7699

NOC DRUGS, INHALATION SOLUTION ADMINISTERED THROUGH DME

J7799

NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME

J8499

PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS

J8597

ANTIEMETIC DRUG, ORAL, NOT OTHERWISE SPECIFIED

J8999

PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS

J9999

NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS

Q0181

UNSPECIFIED ORAL DOSAGE FORM, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR A IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN

Suppliers are reminded to use the most appropriate HCPCS code before using a miscellaneous HCPCS code.

Miscellaneous Findings

A diluent is a solution used to dilute or reconstitute a drug from a powder or liquid form. Suppliers billing for a diluent should use a specific HCPCS code when one is available.
Examples of HCPCS codes used as diluents are:

A4216

STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML

A4217

STERILE WATER/SALINE, 500 ML

A4218

STERILE SALINE OR WATER, METERED DOSE DISPENSER, 10 ML

J7042

5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)

J7050

INFUSION, NORMAL SALINE SOLUTION , 250 CC

J7060

5% DEXTROSE/WATER (500 ML = 1 UNIT)

J7070

INFUSION, D5W, 1000 CC

J7100

INFUSION, DEXTRAN 40, 500 ML

J7110

INFUSION, DEXTRAN 75, 500 ML

J7120

RINGERS LACTATE INFUSION, UP TO 1000 CC

J7130

HYPERTONIC SALINE SOLUTION, 50 OR 100 MEQ, 20 CC VIAL

J7131

HYPERTONIC SALINE SOLUTION, 1 ML

Hydration Therapy should be billed with the hydration fluid HCPCS code when one is available. The following are examples of codes used for hydration therapy:

J7042

5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)

J7050

INFUSION, NORMAL SALINE SOLUTION , 250 CC

J7060

5% DEXTROSE/WATER (500 ML = 1 UNIT)

J7070

INFUSION, D5W, 1000 CC

J7100

INFUSION, DEXTRAN 40, 500 ML

J7110

INFUSION, DEXTRAN 75, 500 ML

J7120

RINGERS LACTATE INFUSION, UP TO 1000 CC

J7130

HYPERTONIC SALINE SOLUTION, 50 OR 100 MEQ, 20 CC VIAL

J7131

HYPERTONIC SALINE SOLUTION, 1 ML

Please refer to your Durable Medical Equipment Medicare Administrative Contractor (DME MAC) for coverage, billing instructions and use of modifiers.

For questions about correct coding, contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC website: https://www.dmepdac.com/.

Published by Noridian as the PDAC, September 2014.  Republished by Palmetto GBA as the PDAC, February 2019.  Please note that links in this document were accurate at the time of original publication and may change over time and are no longer active.



Last Updated: 09/18/2014