Retired - 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/.
| Date | Revision |
|---|---|
| 09/18/2014 | Published on PDAC website |
| 05/09/2022 | Retired |