Cracking the Code
Coding J Codes
J codes are identifiers and descriptors found in the HCPCS code book and are specific to drugs and biologicals as well as injectable chemo drugs. These drugs can be injected by one of three means: subcutaneously, intramuscularly, or intravenously. They can also be applied topically, inhaled, or taken orally or parenterally. There is a subcategory for contraceptive devices such as intrauterine devices (IUD). Each drug is associated with specific dosage units as a part of the J code description. When the administered dosage exceeds the “dose unit” in the code description, the additional units must be reported on the claim form to ensure reimbursement for the entire dosage given to the patient.
Medicare reimburses for a few drugs or medications for certain medical conditions only. It is important to note that the diagnosis as documented in the patient’s medical chart and supported by laboratory and other tests must show medical necessity. If it does not show medical necessity, the service would not be covered. As always, you should check with the MAC for diagnoses included for a drug as supporting medical necessity according to the Medicare policy.