CPCA HCPCS Coding for Injectables 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?

Accepted Answer

J0585 with 28 units

Answer

J0585 with 1 unit

Answer

J0588 with 28 units

Answer

The drug is bundled with the administration code and not reported separately.

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?

Accepted Answer

25

Answer

2.5

Answer

10

Answer

3

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?

Accepted Answer

The National Drug Code (NDC) of the product administered

Answer

The lot number of the drug vial

Answer

The time of day the injection was given

Answer

The name of the pharmacist who dispensed the drug

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?

Accepted Answer

Bill J0588 for 80 units on one line, and J0588 with the JW modifier for 20 units on a separate line.

Answer

Bill J0588 for 100 units on a single line.

Answer

Do not bill for the discarded amount, only the 80 units administered.

Answer

Bill J0588 for 80 units and add the cost of the wasted drug to the office visit charge.

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?

Accepted Answer

J3590 (Unclassified biologics)

Answer

J9999 (Not otherwise classified, antineoplastic drugs)

Answer

99070 (Supplies and materials)

Answer

C9399 (Unclassified drugs or biologicals)

Question 6

Which of the following HCPCS codes correctly identifies the supply of incobotulinumtoxinA, 1 unit?

Accepted Answer

J0588

Answer

J0585

Answer

J0586

Answer

J0587