Sunday, January 20, 2013

HCPCS Changes in Depo Provera Coding for 2013


New HCPCS code: 
J1050  (Injection, medroxyprogesterone acetate, 1 mg)

Deleted codes: (as of December 31, 2012)
J1051 (Injection, medroxyprogesterone acetate, 50 mg), 
J1055 (Injection, medroxyprogesterone acetate for contraceptive use, 150 mg) and 
J1056 (Injection, medroxyprogesterone acetate/estradiol cypionate, 5 mg/25 mg) 
Effective January 1, 2013, injection administration of medroxyprogesterone acetate (Depo-
Provera) should be reported using HCPCS code J1050 . Due to the change in dosage from the discontinued codes, when reporting code J1050, the appropriate dosage (measured in units) should be reported based on the specific needs of the patient.


This change means that you will code/bill the HCPCS code as J1050 x the amount units given.  (eg.  If the provider is giving 50 units then you should code as: J1050 x 50 units.  If the provider is giving 150 units then you should code as J1050 x 150 units.)  The appropriate diagnosis also needs appended to the claim.  If the provider is giving the drug for a diagnosis such as menorrhagia,  abnormal menstrual bleeding, or other gynecologic reason, the code J1050 should be reported using the exact amount of drug used per patient.  

Medical necessity should always be the driving factor for any therapy given and all orders and  documentation must be noted.

In addition, you will need to report the injection administration with CPT code 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular). However, CPT code 96372 requires direct supervision of a physician or other qualified health care professional (unless administered in a hospital setting)



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8 comments:

  1. AnonymousFebruary 1, 2013 at 1:43 PM

    I have been readying alot about this J 1050 and for billing purposes does 150 mg = 150 units?

    ReplyDelete
    Replies
    1. Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPFebruary 1, 2013 at 6:45 PM

      Yes - If you are giving the 150 mg dose for contraception, then the J1050 code needs submitted as J1050 with 150 units. : )

      Delete
    2. AnonymousJune 10, 2013 at 5:11 PM

      I don't believe you are correct about charging 150 units.

      Delete
    3. Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPJune 10, 2013 at 7:31 PM

      According to ACOG, In addition to HCPCS you bill code J1050 in 1mg "units" based upon the need and diagnosis of the patient. If the patient need 100 mg's then you will bill code J1050 x 100 units. If the patient needs 150 mgs', then you will bill 150 units. For verification, please review the 2013 HCPCS book, or you can review the ACOG site also. http://www.acog.org/About_ACOG/ACOG_Districts/District_II/Changes_in_Depo_Provera_Coding

      Delete
  2. AnonymousFebruary 4, 2013 at 10:27 AM

    Do you have NDC numbers for billing that go with J1050?

    ReplyDelete
  3. Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPMarch 7, 2013 at 9:59 PM

    NDC codes are found on the national NDC listing http://www.accessdata.fda.gov/scripts/cder/ndc/results.cfm?searchfield=medroxyprogesterone%20acetate&searchtype=ActiveIngredient&OrderBy=SubstanceName

    ReplyDelete
  4. AnonymousMay 13, 2013 at 12:03 PM

    Thank you, this information is such a big help. I do have a question though, how much do you bill it per unit?

    ReplyDelete
    Replies
    1. Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPMay 13, 2013 at 12:32 PM

      The amount billed per unit, is not the same across the board. You will need to know how much your retail cost is per unit. That can be found if you are billing a 150 units from 1 vial. If the cost of the vial is $100.00 retail, then you would divide the cost of $100.00 by 150 units which you would then bill as $0.667 per 1 mg unit on your claim. L : )

      Delete

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