I have been dealing with J-code and revenue code problems for the past
several months. For instance, today, we had Cytoxan claims rejected by
Medicare because we had old J-codes of J9095 for the 500 mg vial and J9096
for the 1 gm vial with a multiplier of 1 for each. Now, I find out that
effective 1/1/06, J9093 which is in 100 mg increments, is supposed to be
used for all Cytoxan products. However, I have the new "Payment Allowance
Limits for Medicare Part B Drugs" which is effective from 10/1/06 through
12/31/06 and they have J9070 for 100 mg, J9080 for 200 mg, J9090 for 500
mg, J9091 for 1 gm, and J9092 for 2 gm; no mention of J9093. Could someone
please explain this.
For revenue codes, does every drug with a HCPCS code get placed in
636? What is the difference between revenue code 250 which is drugs and 251
which is generic drugs?
Does anyone know a phone number of a someone at CMS who can accurately
answer any questions that I would have regarding J-codes or revenue codes.
Accounting and billing say that they don't know and that it is pharmacy's
responsibility that these codes be correct. However, trying to find these
things on the CMS web site is near impossible, and deciphering some of the
information is impossible. Our hospital is using Craneware, but even that
still lists the wrong Cytoxan J-codes as active and lists multiple revenue
codes for things such as Cytoxan (250, 251, and 636).
Thanks,
Charlie
Charles Downs Pharm.D.
Washington County Hospital
Inpatient Pharmacy
251 E. Antietam Street
Hagerstown, MD, 21740
301-790-8904
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