CPCA HCPCS Coding for Injectables Questions and Answers — Questions and Answers
Question 1: A patient receives 28 units of onabotulinumtoxinA for the treatment of glabellar lines. The HCPCS Level II code is J0585, which is defined as 'Injection, onabotulinumtoxinA, 1 unit'. How should the supply of the drug be reported on the claim form?
- J0585 with 1 unit
- J0588 with 28 units
- J0585 with 28 units (Correct answer)
- The drug is bundled with the administration code and not reported separately.
Correct answer: J0585 with 28 units
The correct HCPCS code for onabotulinumtoxinA (Botox) is J0585. The code descriptor specifies '1 unit'. Therefore, if 28 units are administered, the number of units reported on the claim should be 28. J0588 is the code for incobotulinumtoxinA (Xeomin). The drug supply is billed separately from the administration procedure.
Question 2: A physician administers 2.5 mL of deoxycholic acid from a vial with a concentration of 10 mg/mL to reduce submental fat. The HCPCS code is J0591, which represents 'Injection, deoxycholic acid, 1 mg'. How many units of J0591 should be billed?
- 2.5
- 10
- 3
- 25 (Correct answer)
Correct answer: 25
To determine the correct number of units, the total dosage in milligrams must be calculated. The patient received 2.5 mL of a 10 mg/mL solution, which equals 25 mg (2.5 mL x 10 mg/mL). Since the HCPCS code J0591 represents 1 mg of the drug, the correct number of units to bill is 25.
Question 3: When billing for an injectable drug using a J-code, which of the following pieces of information is essential to include on the claim form for many payers to ensure accurate processing and reimbursement?
- The lot number of the drug vial
- The National Drug Code (NDC) of the product administered (Correct answer)
- The time of day the injection was given
- The name of the pharmacist who dispensed the drug
Correct answer: The National Drug Code (NDC) of the product administered
For accurate claim processing and to meet the requirements of many payers, including state Medicaid agencies, the 11-digit National Drug Code (NDC) of the specific drug product administered must be reported on the claim. This allows for precise identification of the manufacturer, drug, strength, and package size, which is not captured by the HCPCS code alone.
Question 4: A provider uses a 100-unit single-dose vial of incobotulinumtoxinA (HCPCS J0588) to treat a patient. The provider administers 80 units and must discard the remaining 20 units. According to CMS guidelines, how should the discarded portion be billed?
- Bill J0588 for 100 units on a single line.
- Do not bill for the discarded amount, only the 80 units administered.
- Bill J0588 for 80 units on one line, and J0588 with the JW modifier for 20 units on a separate line. (Correct answer)
- Bill J0588 for 80 units and add the cost of the wasted drug to the office visit charge.
Correct answer: Bill J0588 for 80 units on one line, and J0588 with the JW modifier for 20 units on a separate line.
When a portion of a drug from a single-dose vial is discarded, the JW modifier is used to report the wasted amount. The administered dose (80 units) should be billed on one claim line, and the discarded amount (20 units) should be billed on a separate claim line with the same HCPCS code (J0588) and the JW modifier appended.
Question 5: A physician administers a newly FDA-approved injectable biologic that does not yet have a specific HCPCS Level II code. Which of the following codes would be most appropriate to use for billing the drug supply?
- J9999 (Not otherwise classified, antineoplastic drugs)
- 99070 (Supplies and materials)
- J3590 (Unclassified biologics) (Correct answer)
- C9399 (Unclassified drugs or biologicals)
Correct answer: J3590 (Unclassified biologics)
HCPCS code J3590 is designated for 'Unclassified biologics' and is the appropriate code to use when a specific code has not yet been assigned to a new biologic drug. J3490 is for unclassified drugs in general, but J3590 is more specific for biologics. J9999 is for chemotherapy drugs, C9399 is for hospital outpatient use, and 99070 is a CPT code for supplies not typically used for separately billable drugs.
Question 6: Which of the following HCPCS codes correctly identifies the supply of incobotulinumtoxinA, 1 unit?
- J0585
- J0588 (Correct answer)
- J0586
- J0587
Correct answer: J0588
HCPCS code J0588 is assigned to 'Injection, incobotulinumtoxinA, 1 unit'. J0585 is for onabotulinumtoxinA, J0586 is for abobotulinumtoxinA, and J0587 is for rimabotulinumtoxinB. It is critical to select the code that matches the specific drug administered.
CPCA HCPCS Coding for Injectables Questions and Answers
A patient receives 28 units of onabotulinumtoxinA for the treatment of glabellar lines.
The HCPCS Level II code is J0585, which is defined as 'Injection, onabotulinumtoxinA, 1 unit'.
How should the supply of the drug be reported on the claim form?