03/04/2002    Steven S Melek, DPM

Billing for Cortisone Injectable Supply

Query: Billing for Cortisone Injectable Supply
From: Steven S Melek, DPM

When using the injection codes, CPT 20550, CPT
20551, CPT 20600, and CPT 20605, if I use a
corticosteroid injectable supply (e.g.,
dexamethasone), can I bill the "J" injectable
supply code with the appropriate injection code?
Thank you.

Steven S Melek DPM
Chapmanville, WV
drstevenscott@yahoo.com

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[Codingline-L] Response:

You most certainly can and should. The
therapeutic injectable supply (e.g.,
dexamethasone sodium phosphate, 1 mg - J1100) is
not included in any of the injection codes you
listed. CPT guidelines state that "Supplies and
materials provided by the physician (e.g.,
sterile trays/drugs), over and above those
usually included with the procedure(s) rendered
are reported separately. List drugs, trays,
supplies, and materials provided."

Unless there is a direct medication inclusion
built into the injection administration code,
you should bill the therapeutic medication
(i.e., cortisone) separately. HCPCS contains the
listing of injectable medications and the code.

Be sure to pay special attention to the dosage
of injectable administered because this will
affect your billing. If, for instance, you
administered 2 mg of dexamethasone sodium
phosphate instead of 1 mg, your HCFA-CMS 1500
claim billing would reflect a "2" in the unit
box. And your charge would be increased to
reflect the doubling of the medication used. The
pricing of the injectable supply is an
individual provider consideration...and will be
reimbursed in accordance with the particular
payer's fee schedule allowance. Be sure to list
the type of injection, the injectable material
used and the dosage within your medical record
documentation.

Keep in mind - for those practitioners that
currently do not bill for the therapeutic (e.g.,
cortisone) supply - even Medicare usually pays
something for them. And if the reimbursement is
tiny, it 1) only cost you the time to print one
additional line item to your HCFA-CMS 1500 form
and 2) goes directly against the actual cost of
the medication (overhead supply).

[Codingline-L] Expert Panelist: Harry Goldsmith,
DPM

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