Rocephin Shot Injection (IV/IM(Ceftriaxone) ) : Coding and Billing Aspects

Rocephin is a cephalosporin antibiotic used to treat different type of bacterial infection and severe condition like meningitis.

Image result for rocephin shot

Correct coding of rocephin shot injection can increase medical reimbursement . Its needed at least three codes :

  • Supplies
  • Administration Code
  • E/M Codes

 

 

 

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Supplies:  J0696 Rocephin Injection, Ceftriaxone Sodium, Per 250 mg

HCPCS code J0696 can be charged per unit. Generally it is administered 250 mg or 1 unit. For each 250 mg of Rocephin, you should bill one unit of J0696. If we use a partial unit, such as 600 mg, round up to the next unit.

Doses                             Code:
250 mg                      J0696 x 1 unit
500 mg                      J0696 x 2 units
600 mg                      J0696 x 3 units

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Administration Code:  Use 96372 for the Injection (CPT deleted 90782 and 90788)

90782:  (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular). But it is not used for antibiotic.

Whereas  90788: Intramuscular injection of antibiotic (specify).

NOTE: 90782 sometimes uses mistakenly . Be attentive with admin code . 90788 is correct admin code because its specific for antibiotics.

But now-a- days we are using  96372 for administration of injection because 90782 and 90788  has been deleted.  Code 96372 represents an intramuscular injection.

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E/M Codes: 99201-99215 E/M Code for office visit

When the patient comes for check up and he/she is suffering from fever with a severe infection, and physician decides to give them Rocephin shot  then the level of visit may qualify high level like, 99214 or 99215. 

Another case if patient has already taken antibiotics in hospital because of severe infection. Now he is coming for follow-up visit  in office and physician need to give them Rocephin shot. This is also a high level E/M .

Note :

  • Rocephin injection uses in infectious cases so it will have some history. So focus on history that will surely helpful in increasing E/M level and reimbursement.
  • Correct admin codes can increase medical reimbursement revenue. So assign admin code with supplies.
  • Modifier 25 should also apply . otherwise administration code will be bundled. we can’t get seperate payment.

 

 

 

 

 

 

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